tci Outpatient Facility Coding Alert - 2018 Issue 8

E/M Coding: Consider These Factors When Billing Modifier 57 With Minor Surgical Procedures

Don’t let the plethora of conflicting guidelines overwhelm you. Most coders working in physician offices or clinics don’t think twice about reporting modifier 57 (Decision for surgery) when the situation calls for it. That’s because it’s one of those modifiers that’s seemingly clear on the surface. If a patient sees a provider for an evaluation and management (E/M) visit that results in a decision for a same day (or the day prior to) surgery, then you should use modifier 57, right? Problem: Unfortunately, when you are billing for the surgeon’s services in outpatient...

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