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Q&A Decision for Surgery

D

Donna555

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If the physician documents for a possible surgery and then the next day it is decided for sure that there will be a surgery, which day gets the modifier 57? Is the wording "possible surgery" considered the decision for surgery?
 
L

Laureen

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Blitzer
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The purpose of 57 is to differentiate it from the pre-op visit which is bundled into the surgery code. In this case I'd put a 57 on the EM where they indicated "possible surgery" but if no surgery actually occurred it would be a mute point and not needed.
 
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