What modifier to determine surgery?
Asked by: Kelli DuBuque | Last update: October 1, 2025Score: 4.6/5 (69 votes)
What is the 57 modifier for surgery?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
When to use 59 or 51 modifier?
Modifier -51 would be attached because the biopsy is the lesser-valued procedure done at the same session, and modifier -59 would be attached to indicate that the biopsy, which is normally bundled with excision of the same lesion, was done on a separate lesion from the one that was excised.
What is the modifier for determining surgery?
Modifier 57 should be appended to any E/M service on the day of or the day before said procedure when the E/M service results in the decision to go to surgery. This informs the payer that the physician determined the surgery was medically necessary. Modifier 57 should only be appended to E/M codes.
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 a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
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.
What modifier indicates a decision for surgery?
What You Need To Know. Modifier 57 is used to indicate an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90 day global) or the day of a major surgery.
What is the modifier 22 for surgery?
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.
When to use 53 modifier?
CPT modifier 53 for discontinued procedure indicates that a surgical or diagnostic procedure was started but discontinued.
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
What is modifier 50 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 an example of a 51 modifier?
The OBGYN performs a surgical completion of the miscarriage and inserts the requested IUD during this visit. Modifier 51 would be applicable in this scenario as follows: 58912 (incomplete abortion completed surgically) 58300-51 (insertion of IUD)
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 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 an inappropriate use of the 57 modifier?
E/M Services Resulting in Minor Surgical Decisions
Avoid using modifier 57 for minor procedures. Insurance companies do not accept this modifier with Evaluation and Management (E/M) services where the doctor decides to perform a simple operation—surgery with a 0 or 10-day global period.
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 the 57 modifier used for?
Answer: Modifier -57 is appended to office visits the same day or within three days of a major surgery (90-day global period).
Is modifier 79 used for surgery?
Modifier 79 is used to indicate an unrelated procedure performed by the same physician during the postoperative period of the original surgery.
What modifier is used in surgery?
Another common use of modifiers 59 or XE is for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures performed during different patient encounters on the same day that can't be described by 1 of the more specific NCCI PTP-associated modifiers – in other words, 24, 25, 27, 57, 58, 78, 79, ...
What is a 22 modifier?
Modifier 22 is defined as increased procedural services. Under certain circumstances, it may be necessary to indicate that a procedure or service is significantly greater than usually required.
Can I use a 24 and 57 modifier together?
You can append both modifiers 24 and 57 to E/M codes when the E/M service is either unrelated to a surgery (modifier 24) or results in the decision to perform the bundled procedure (modifier 57).
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 the 54 modifier used for?
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 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.