Thursday, November 25, 2010

Surgery modifier list - which modifier to use

Modifier 57: Denotes decision for surgery. This modifier will be allowed when
appended to an Evaluation and Management code either 1 day prior OR same day as a
MAJOR (90 day global) surgical procedure. Please follow CMS guidelines for global
days, as listed in the CMS Physician Fee Schedule.

Modifier 59: Denotes distinct procedural service. This modifier will be allowed when
appended to procedures or service that are not routinely reported together. Please
follow CPT guidelines as outlined in Appendix A of the current year CPT Manual.

Modifier 62: Denotes two surgeons working together as primary surgeons. Both
surgeons should submit this modifier on only those services where they are acting as
primary surgeons. See Co-Surgery, SUR701.002 in the Medical Policy Manual for more
information. NOTE: Physicians acting as co-surgeons cannot bill as assistants.

Modifier 66: Denotes surgical team. See modifier 62 above.

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