tci ED Coding & Reimbursement Alert - 2004 Issue 8

Reader Question: Forgo -57 for Patients Headed Directly to OR

Question: When should I use modifier -57 (Decision for surgery)? Does this modifier apply to patients admitted to the hospital who go directly to the operating room? Does it apply to patients who receive laceration repair or fracture care? Should I append this modifier to the E/M code? Kansas SubscriberAnswer: You should append modifier -57 when the evaluation and management service the doctor performed resulted in the decision for surgery -- for example, an emergency department physician's examination of a patient that revealed a fractured tibia. You should report the E/M code -- in this case, possibly 99284 (Emergency...

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