May 12, 2016

Question:
If I see a consult in the ER and during that visit I identify the need for surgery the same day, can I append a Modifier 57 to the E/M service and get paid?

Answer:
You determine during the evaluation that the patient would need surgery the same or next day for a major procedure (90 day global), append modifier 57 to the E/M service. If the procedure is a minor procedure with a at 0- or 10 day global and the E/M service is significantly separately identifiable, report the E/M service with modifier 25. Use caution when appending the 25 Modifier as CMS has indicated that there is an inherent E/M service in every procedure and routine use of Modifier 25 may create payer scrutiny.

*This response is based on the best information available as of 05/12/16.