What is the 57 modifier used for?
Asked by: Deshawn Beahan V | Last update: April 17, 2025Score: 4.2/5 (43 votes)
What is the difference between modifier 57 and 59?
The Modifier 57 is appended to the E/M visit to indicate that service resulted in the decision to go to surgery. Modifier 59 should be used to report procedures or services that are not normally reported together but are appropriate under the circumstances.
When should modifier 58 be used?
To start, modifier 58 is a surgical-specific modifier, used to indicate a staged or related procedure or service by the same physician during the postoperative period.
What is modifier 59 most commonly used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is a 52 modifier used for?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
Modifier 57 Decision for Surgery explained medical coding
What is the 50 modifier used for?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
What is modifier 53 used for?
Appropriate use modifier 53:
Bill modifier 53 with the CPT code for the service furnished. This modifier is used to report a service or procedure when the service or procedure is discontinued after anesthesia is administered to the patient.
What is modifier 60 used for?
The CPT manual introduced modifier -60 in 2001 to allow providers to indicate when a procedure was more complex than normal due to an altered surgical field.
What is modifier 51 used for?
CPT guidelines explain the 51 modifier should apply when “multiple procedures, other than E/M services, are performed at the same session by the same individual. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s).”
What is modifier 55?
Modifier 55
Postoperative Management Only. When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.
What is modifier 62?
Definitions. Modifier 62. Current Procedural Terminology (CPT®) - modifier 62 describes when two surgeons of the same or different specialties work together as primary surgeons performing distinct part(s) of a surgical procedure. Co-Surgeon Indicators.
What is modifier 80?
Current Procedural Terminology (CPT®) Modifier 80 - CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon.
When should modifier 57 be used?
Modifier -57 is appended to office visits the same day or within three days of a major surgery (90-day global period). It indicates the office visit includes the decision for the major procedure.
What is a 58 modifier used for?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
What is an example of a 57 modifier?
For example, a surgeon sees a patient and determines (and appropriately documents) that patient needs an emergency appendectomy. Because the E/M led to the decision for surgery, both the E/M (with modifier 57 appended) and the surgery may be reported, with separate payment for each.
When to use modifier 90?
Independent laboratories shall use modifier 90 to identify all referred laboratory services. A claim for a referred laboratory service that does not contain the modifier 90 is returned as unprocessable if the claim can otherwise be identified as being for a referred service.
What is modifier 22 used for?
Modifier -22: Increased Procedural Services. This modifier is used to identify a service that requires significantly greater effort, such as increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required, than is usually needed for that procedure.
What is a 24 modifier?
Modifier 24 is defined as an unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period.
What is modifier 56 used for?
Modifier 56 is used for preoperative management only when a qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure.
What is modifier 50?
The modifier 50 is defined as a bilateral procedure performed on both sides of the body.
What is a 25 modifier?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
What is the 55 modifier for?
POSTOPERATIVE MANAGEMENT ONLY: WHEN ONE PHYSICIAN PERFORMS THE POSTOPERATIVE MANAGEMENT AND ANOTHER PHYSICIAN HAS PERFORMED THE SURGICAL PROCEDURE, THE POSTOPERATIVE COMPONENT MAY BE IDENTIFIED BY ADDING THE MODIFIER -55 TO THE USUAL PROCEDURE NUMBER OR BY USE OF THE SEPARATE FIVE DIGIT MODIFIER CODE 09955.
What is a 59 modifier?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services.
What is modifier 74 used for?
Modifier 74 appended to anesthesia or surgical procedures when discontinued. AFTER anesthesia administration induced or procedure initiated. ASC or outpatient hospital only. Due to medical complications, extenuating circumstances, or threat to patient well-being.