Denise Posted Thu 28th of June, 2012 16:42:09 PM
Pt was seen in the office/clinic and scheduled for a PFT as an
OP. Same provider that saw pt.in office is interpreting the PFT.
OV was billed out before we received PFT charges. Does the OV
need a 25 modifier?
SuperCoder Answered Thu 28th of June, 2012 19:06:19 PM
The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier -25."
Modifier 57 is a modifier that is appended to an E/M service to indicate that this was the visit at which the physician decided to perform surgery. It is only used on procedures with a 90 day global period, per CMS, although this is not a CPT® rule. It is only used the day of or before a major surgical procedure. (For a minor surgical procedure, with 0 or 10 global days, no modifier is needed the day before the service, and a 25 modifier is needed the day of the service, if the E/M service was a distinct, separate procedure