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

The payment for major surgery includes E/M services provided on the day of and the day before a major surgical procedure, unless it is the visit at which the decision for surgery was made.

• A major surgical procedure is a procedure with 90 global days.
• Only use modifier 57 on the visit for which the decision for surgery was made when the major surgery will be done that day or the next day.
• Use modifier 57 on the E/M service—office visit, ED visit, initial hospital service, critical care service or any E/M service.
• Allows physician to be paid for the initial evaluation that results in surgery the same day or the day before the surgery.
• Use to indicate to the payer that an E/M service is a significant, separate service from other procedures performed on same day.
• A different diagnosis is not required.