What is the primary purpose of Modifier -57?

Modifier -57 serves a specific function in coding related to surgical decision-making. Its primary purpose is to indicate that a physician made a decision to perform surgery either on the day prior to the surgical procedure or on the same day that the surgery took place. This modifier is essential for signifying that an evaluation and management (E/M) service led directly to the decision for surgery, helping to clarify the relationship between the visit and the surgical action that follows.

When this modifier is applied, it underscores the key point that the patient's encounter was not simply a routine visit but was instead significant in the context of a surgical decision. This can have implications for reimbursement and ensures that the medical necessity for surgery is evident in the coding.

Understanding the nuanced use of Modifier -57 is important for coders as it can affect how claims are processed and whether they are approved for payment by insurance payers. By recognizing its role, coders can adequately represent the clinical interactions that lead to surgical interventions.