Correct Usage of Modifier 57


Practicefirst would like to like to remind its clients about the correct usage of modifier 57, Decision for Surgery. This modifier at first glance looks easy to code, but is often used incorrectly and has made it to the list of open issues for the Recovery Audit Contractors (RAC).

A few items to remember when using modifier 57:

  • This modifier is used only on the E/M codes and not on the procedures.

  • This modifier is NOT to be used on any minor procedure (0 to 10-day global period)

  • It is appropriate using modifier 57 with an E/M on the day before or the day of a major surgical procedure (90-day global period).

For more information please access the RAC link for our region (Region 1):

https://performantrac.com/audit-regions/region-1/

For Coding questions, please contact our Coding Supervisors, Vidya Baliga at 716-389-3220 or vidyab@pracfirst.com and Kelly Cole at 716-389-3262 or kellyc@pracfirst.com

275 Northpointe Pkwy, Suite 50

Amherst, NY 14228

866.234.5017 (Toll-free)

info@pracfirst.com

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