What is the modifier for decision regarding surgery?
Asked by: Ms. Mercedes Heathcote IV | Last update: November 10, 2025Score: 4.5/5 (1 votes)
What is the modifier 57 decision for surgery?
FYI: The 'Decision for surgery' modifier (57), means that, during that E/M encounter, the provider made the decision to perform a major surgery (eg, one with a 90 day global). Normally you see it on a day that comes before the surgery date, but it's also correct to use, if it's on the same date.
What is a modifier 25 decision for surgery?
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 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.
What is modifier 78 and 79?
Modifier 78 Definition: “Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period.” Modifier 79 Definition: “Unrelated procedure or service by the same physician during a post-operative period.”
Modifier 57 Decision for Surgery explained medical coding
What is modifier 73 used for?
Use modifier 73 to report discontinued outpatient/hospital ambulatory surgical center (ASC) procedure prior to the administration of anesthesia. Physicians should not use this modifier. This is only appropriate for use by the ASC.
What is the 33 modifier used for?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
What is the 59 modifier 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 55 modifier used for?
Postoperative management only. Use this modifier to indicate that payment for the postoperative, post-discharge care is split between two or more physicians where the physicians agree on the transfer of postoperative care.
Which modifier decision for surgery is used?
Modifier -57: Used to indicate that a particular Evaluation and Management (E&M) service performed in the pre-operative period of a major surgical procedure resulted in a decision to perform that surgical service. Major surgical procedure: A surgical procedure that includes a 90-day post-operative period.
When to use modifier 95?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
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 the modifier 25 for decision for surgery?
Modifier 25 indicates on the day of a procedure, the patient's condition required a significant, separately identifiable E/M service, above and beyond the usual pre- and post-operative care associated with the procedure or service performed. E/M service may occur on the same day as a procedure.
What is a 54 modifier?
Modifier 54
When a physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding this modifier to the usual procedure code.
What is a 26 modifier?
• Modifier 26 is appended when a physician provides the professional component only of the global fee. and when the physician prepares a written interpretation and report. • Modifier 26 should only be appended to codes which are listed in the CMS NPFSRVF as modifier 26. appropriate.
What is modifier 62 used for?
Two surgeons. Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session.
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 58 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 a 25 modifier used for?
Modifier 25 – this Modifier is used to report an Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified health care professional.
What is a 74 modifier 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.
What is modifier 82 used for?
CPT Modifier 82 - CPT Modifier 82 represents assistant at surgery by another physician when a qualified resident surgeon is not available to assist the primary surgeon. This modifier is not intended for use by non-physicians assisting at surgery (e.g., Nurse Practitioners or Physician Assistants/Physician Associates).
What is a 52 modifier used for?
Modifier -52 identifies that the service or procedure has been partially reduced or eliminated at the physician's discretion. The basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What is modifier 97 used for?
When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service.
What is modifier 93 used for?
Modifier 93 is a new audio-only telemedicine code that went into effect on Jan. 1, 2022. Modifier 93 describes services that are provided via telephone or other real-time interactive audio-only telecommunications system.