Global Surgery Modifiers

CPT Modifier  :  25

Description : Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure or Other Service: It may be necessary to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or be beyond the usual preoperative and postoperative care associated with the procedure that was performed. A significant, separately identifiable E/M service is defined or substantiated by documentation that satisfies the relevant criteria for the respective E/M service to be reported (see Evaluation and Management Services Guidelines for instructions on determining level of E/M service). The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of the E/M services on the same date. This circumstance may be reported by adding CPT modifier 25 to the appropriate level of E/M service. 

Note: This modifier is not used to report an E/M service that resulted in a decision to perform major surgery. See CPT modifier 57. For significant, separately identifiable non-E/M services, see CPT modifi er 59.

 

CPT Modifier  :  57

Description :

Decision for Surgery: An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding CPT modifier 57 to the appropriate level of E/M service. 

E/M services on the day before or on the day of major surgery (90 day global period) which result in the initial decision to perform the surgery are not included in the global surgery payment.

 These E/M services may be billed separately and identified with the 57 CPT modifi er. This modifier should not be used for visits furnished during the global period of minor procedures (0 or 10 day global period) unless the purpose of the visit is a decision for major surgery. 

This modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. When the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure.

CPT Modifier  :  58

Description :

Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding the CPT modifier 58 to the staged or related procedure. 

Note: For treatment of a problem that required a return to the operating or procedure room (e.g., unanticipated clinical condition), see CPT modifier 78. 

CPT Modifier  :  59

Description :Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. CPT modifier 59 is used to identify procedures or services, other than E/M services, that are not normally reported together but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury (or area in injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than CPT modifier 59. CPT modifier 59 should only be used if there is no other more descriptive modifier available and the use of CPT modifier 59 best explains the circumstances. 

Note: CPT modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see CPT modifi er 25.

 

CPT Modifier  :  78

Description :Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure).

 When this procedure is related to the first and requires the use of an operating room, it may be reported by adding CPT modifier 78 to the related procedure. (For repeat procedures, see CPT modifi er 76).

 CPT Modifier  :  79

Description :Unrelated Procedure by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. 

This circumstance may be reported by using the CPT modifier 79. (For repeat procedures on the same day, see CPT modifi er 76).