decisionhealth Newsletters, Answer Books - 2011 Issue 9 (September)
Modifier 25 vs. 57 / Modifier 57
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Article Overview
This article covers how E/M services are viewed around surgical procedures and the distinction between two modifiers often discussed in surgical billing. It is aimed at coders, billers, and revenue cycle staff who need a high-level understanding of when these modifiers are relevant and how payer policy can affect their use.
Why This Topic Matters
Correctly identifying the relationship between an evaluation and management service and a surgical procedure affects claim handling and global surgery payment treatment. The article is relevant for avoiding confusion between similar modifiers and for understanding that payer policy may differ.
What You Will Learn
- How E/M services are considered in relation to surgical global periods
- The difference between two surgery-related E/M modifiers
- Why payer policy matters when evaluating modifier use
- How coding references can distinguish the E/M service from the procedure claim
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice administrators
- Compliance staff
Modifiers Discussed
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