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1 Jan 2000 standard coding guidelines (including but not limited to UB Editor, AMA, CPT, CPT Assistant, HCPCS,. DRG guidelines, CMS' National Correct Coding Initiative (CCI/NCCI) Policy Manual, CCI table edits and other CMS guidelines). Benefit determinations will be based on the applicable member contract

Description: Decision for surgery. Guidelines/Instructions: 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. Documentation in the patient's
In addition to the CPT E/M code, modifier “-57” (Decision for surgery) is used to identify a visit that results in the initial decision to perform surgery. The modifier “-57” is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery.
21 Feb 2017 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 Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12,
17 May 2016 A major procedure is a procedure with 90 global days. An initial evaluation prior to a major surgical procedure is always payable. When this initial evaluation results in the decision for surgery on that calendar day or the next calendar day, append modifier -57 as the decision for surgery modifier to the E/M service.
You should apply modifier 57 (Decision for surgery) only when an E/M service precedes a surgical procedure with a 90-day global period. Medicare restricts modifier 57 to major surgeries, and the Medicare Internet Only Manual (IOM), section 40.2, specifically instructs carriers not to pay -for an evaluation and management
30 Mar 2009 When deciding if you should append modifier 57, ask yourself, “Did the E/M service determine the need for a major procedure.” The CPT® manual doesn't define “major” or “minor” procedures, but CMS does, and many other payers follow CMS's lead. Specifically, CMS defines a major procedure as any
Effective Date: July 5, 2016. Purpose: Implementation of this policy would provide cost avoidance by preventing E&M services involving a decision for surgery for procedures with 0 or 10 day global surgical from paying. This handling is consistent with CMS guidelines and Horizon NJ Health should be following this
23 May 2017 Modifier 57. Decision for Surgery: An evaluation and management (E/M) service that resulted in the initial decision to perform the surgery may be material, publications, and Medicare guidelines, internally within your organization within the United States for the sole use by yourself, employees and agents.
     

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