Modifier 25 and 57

When a patient is seen for a new condition/diagnosis and a procedure is rendered that day, you should report the evaluation and management (E/M) visit with modifier 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service appended.

Do not report an E/M service routinely with every procedure. Most procedures include an element of E/M; therefore, the E/M service must be able to stand by itself as a truly significant and separately identifiable service to append modifier 25 appropriately.

For Medicare and other payers (check with your individual private payers for guidance), you should append modifier 57 Decision for surgery—rather than modifier 25—if the E/M service prompts the decision to render a major procedure (defined by Medicare as a procedure with a 90-day global period) within 24 hours of the E/M service. Modifier 25 is appropriate when an E/M service is provided on the same day as a minor procedure (defined by Medicare as having a 0-day, 10-day, or “xxx” global period).