Policy Statement
An E&M service provided the day before or the day of a Major Procedure that resulted in the initial decision to perform surgery is eligible for reimbursement if modifier 57 is appended to the E&M code.
Modifier 57 should not be used when the E&M service is associated with a Minor Procedure.
Modifier 57 should not be used when the E&M service was for the preoperative evaluation (when the decision to perform surgery has already been made and the purpose of the exam is a “pre-op visit” to evaluate the current medical status of a patient before a scheduled surgical procedure).
The submission of modifier 57 appended to an E&M procedure code indicates that documentation is available in the patient’s records confirming that the E&M service resulted in the initial decision to perform the surgery.
References
Cross References
