Current procedural terminology modifiers 25 and 57 may be confusing to some coders, but each serves a specific purpose, according to an AAPC report.
When to use modifier 25 —
For an evaluation and management visit when a patient is seen for a new diagnosis and has the minor procedure the same day. Note: Do not report E/M services with every procedure.
When to use modifier 57 —
For Medicare and other payers if the E/M service prompts the decision for a major procedure within 24 hours.
CPT copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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When to use modifier 25 —
For an evaluation and management visit when a patient is seen for a new diagnosis and has the minor procedure the same day. Note: Do not report E/M services with every procedure.
When to use modifier 57 —
For Medicare and other payers if the E/M service prompts the decision for a major procedure within 24 hours.
CPT copyright 2013 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
More Articles on Coding, Billing and Collections:
Making the ICD-10 Transition Smoother: 3 Actions
AMA Alters Editorial Process for CPT Change Process
5 Benefits of ICD-10 for Physicians