What is CPT Modifier 57?
Modifier 57 is a CPT modifier that shows that a doctor made a clear and final decision for surgery during an Evaluation and Management service, also called an E and M visit. In simple words, Modifier 57 is used when the doctor checks the patient, understands the medical problem, and decides that the patient needs major surgery . This decision happens on the same day or one day before the surgery. The modifier tells the insurance company that this visit was not a normal check-up. It was the visit where the doctor decided, “Yes, surgery must be done.”
Modifier 57 exists because major surgeries have global periods , like 90 days. In a global period, many services are included inside the surgery payment. Without Modifier 57, the E and M service on the day of surgery may get denied because insurance will say, “This visit is part of the surgery payment.” But Modifier 57 protects the claim. It tells the payer that this E and M was special. It was not routine. It was the moment the doctor made the final surgery decision.
This modifier is only used for major surgical procedures . A major procedure is usually a CPT code with a 90-day global period . Minor procedures, like 0-day or 10-day global period surgeries, do not use Modifier 57. They use Modifier 25 instead. Modifier 57 is only for serious surgeries where the doctor must make a careful decision after checking history, exam, test results, imaging, or symptoms.
Modifier 57 is important because it gives a clear message to the insurance company. It helps prove medical necessity , which means the surgery was needed. It also helps show that the doctor spent extra time making the final decision, and this must be paid as a separate E and M service. Without Modifier 57, many hospitals and clinics lose money because claims get denied.
Insurance companies look for certain signs before they approve Modifier 57. They want to see documentation saying that the decision for surgery was made during that visit. They want to see the symptoms explained clearly. They want to see the exam findings. They want to see that the doctor explained risks and benefits to the patient. They want to see that the doctor signed the note on the same day. When this information is missing, insurance denies the claim. Our Denial Management and Appeals and Disputes Management services help recover these claims.
Modifier 57 also exists to support emergency and trauma situations. Sometimes a patient comes with a serious problem, and the doctor must quickly decide about surgery. Even in this urgent time, Modifier 57 gives financial protection for the E and M visit so the doctor can still bill properly before the surgery happens.
Because of all this, Modifier 57 is a very important part of compliant medical billing. It makes billing clearer, safer, and more accurate. It helps avoid denials, supports audits, and makes sure surgeons and clinics get proper payment for the work they do before surgery.
The Core Rule: “Decision for Surgery” and How CMS Defines It
The most important rule behind Modifier 57 is the term “Decision for Surgery.” CMS (Centers for Medicare & Medicaid Services) gives a very strict meaning to this term. “Decision for Surgery” is the exact moment when the doctor reviews the patient’s condition, checks the facts, and decides that major surgery is medically necessary . This is not an early idea, not a suggestion, and not a plan for later. It is the final decision that surgery must happen, and it must happen soon.
CMS explains that this decision can only be counted when the doctor performs an Evaluation and Management (E and M) service . They need to document history, exam, assessment, and the clear plan. CMS only accepts Modifier 57 when the doctor shows in the note that the surgery decision happened during this E and M visit. If the doctor had already decided earlier, then Modifier 57 does not apply.
CMS defines “Decision for Surgery” using three key points.
First, the decision must be clinically necessary . This means the patient’s condition is serious enough that surgery is the correct treatment. Second, the decision must be made based on evaluation , not only based on phone call or test result alone. Third, the decision must be linked to a 90-day global procedure , which counts as major surgery. Without these three things, Modifier 57 cannot be used.
CMS also says the decision for surgery is not based only on symptoms. The doctor must look at imaging, past records, lab reports, and physical exam. CMS needs proof that the doctor spent time thinking and reviewing medical facts before deciding. This is why the medical note must include the reason why surgery is needed, what other options were considered, and why those options were not chosen.
Another rule from CMS says that the E and M service where the doctor makes the surgery decision must happen on the same day or one day before the surgery. If the doctor made the decision earlier, like a week before, then Modifier 57 cannot be used on the day of surgery. In that case, the E and M visit where the decision was made should have Modifier 57, not the visit on the surgery date.
CMS focuses very strongly on documentation. If the note does not clearly show the moment of decision, insurance will deny the claim. Even if the patient needed surgery, CMS still needs written proof of the decision. CMS also trains auditors to check the wording. They look for statements like “Decision made today to proceed with surgery” or “Patient requires urgent surgery after today’s evaluation.”
The goal of CMS is to make sure the modifier is used only when it is truly required. This keeps claims clean, avoids fraud, and protects the payment system. When someone misuses Modifier 57, it creates audit risk, claim denials, and payment delays. When used correctly, it shows strong compliance and accuracy in medical billing.
How Modifier 57 Changes the Global Surgical Package Billing Rules
The global surgical package is a special billing rule that covers all the services related to a surgery. This package includes the work the doctor does before surgery, during surgery, and after surgery. When a surgery has a 90-day global period , insurance companies say that most visits and follow-ups inside these 90 days are already included in the payment for the surgery. This means the doctor cannot bill extra E and M services unless there is a special reason. Modifier 57 is that special reason.
Modifier 57 changes how the global surgical package works because it tells the payer that the E and M service on the day of surgery or the day before surgery is not included in the surgery payment. It is separate. It must be paid separately because this visit was the moment when the doctor decided the patient needs major surgery. Without Modifier 57, insurance will think this visit is part of the global package and will deny payment.
To understand this clearly, think of the global surgical package like a big box. When the surgery is performed, this box includes normal exams after surgery, routine check-ups, wound care, medication checks, dressing changes, and many standard tasks. But inside this box, CMS does not include the E and M visit that made the final decision for surgery.
Because of this, you must use Modifier 57 to show that this visit is outside the box.
Modifier 57 is used only for the E and M visit that made the surgical decision . Other visits inside the global period do not get Modifier 57. They only get paid separately when they meet a different rule, like Modifier 24 for unrelated E and M service or Modifier 25 for minor procedures. Modifier 57 is the only modifier that breaks the global surgical rule for major surgeries.
Another important point is timing. Modifier 57 applies only when the decision is made within the 24 hours before a major surgery. If the decision was made earlier, that earlier visit should get Modifier 57, not the visit on the day of surgery. Many coders make the mistake of adding Modifier 57 to the pre-op visit on the surgery date even when the decision was made weeks earlier. Insurance will deny this because it breaks the global package rule.
Modifier 57 also affects how the payer reviews medical necessity. When the modifier is added, the payer knows this was a high-value decision. They will check if the E and M note has full history, exam findings, imaging review, and clear reasoning for surgery. If the note is weak, the payer will deny the E and M but still pay the surgery. So the modifier does not protect poor documentation.
Modifier 57 prevents claim denials but only when used correctly.Proper use makes sure accurate Payment Posting and Accounts Receivable (AR) Recovery. It separates the decision visit from the global package, helps the provider get paid for cognitive work, and shows that the doctor performed significant evaluation work before surgery. This makes the claim clean and compliant.
Correct Timing of the Surgical Decision: Same Day vs Pre-Op Day Billing
The timing of the surgery decision is one of the most important rules when using Modifier 57. Insurance companies, CMS, and auditors all follow very strict timing rules. If the timing is wrong, they deny the E and M claim even if the surgery was correct. The main timing rule is very simple: Modifier 57 can only be added when the final decision for major surgery is made on the same day as the surgery or one day before the surgery. Anything outside this window means the modifier is not valid.
When the decision is made on the same day , the E and M visit must be documented before the surgery starts. This means the note must show the time. The patient must first come for an evaluation. The doctor must take the history, do the exam, check imaging or labs, explain the need for surgery, and then write in the medical record that the final decision for surgery was made at that moment. Only then does the surgery begin. If the note is signed after the surgery starts, auditors may deny the E and M because they think the decision was not part of the evaluation.
When the decision is made one day before , Modifier 57 goes on that visit. The next day, on the surgery date, the doctor usually does a quick pre-op check, but that does not get Modifier 57 because the decision was already made the day before. Many coders make the error of placing Modifier 57 on the day of surgery instead of the correct pre-op day. This causes denials because insurance reviewers can see from the documentation that the decision was made earlier.
If the decision is made two or more days before , then Modifier 57 must be placed only on that earlier visit. The visit on the surgery date is routine and included inside the global package. Insurance companies review the timeline very carefully. They look at timestamps, dates on imaging reports, and even the day when consent was signed. If the consent form is signed days earlier, they know the surgery decision was not made on the day of surgery.
Another important timing rule is when the doctor has multiple visits in the same week. For example, the patient may come Monday for pain, come Wednesday with worsening symptoms, and come Thursday when the doctor decides surgery is now required. Only the Thursday visit can have Modifier 57. The earlier visits cannot because they were diagnostic and not part of the final decision.
Emergency cases have special timing rules. In trauma or sudden critical problems, the doctor may need to make the decision instantly. Even then, documentation must show that the decision was made during the E and M service right before the surgery. Even in urgent cases, auditors check timing to see if the modifier was correctly used.
Correct timing is the strongest factor in Modifier 57 approval. If the timing is wrong, the claim fails even when everything else is right. Clear timestamps, complete notes, and proper date selection keep the claim clean and compliant.
| Timing of Final Surgery Decision | Correct Modifier Usage | Where Modifier 57 Goes | Notes |
| Decision on the same day as surgery | Use Modifier 57 | On the E/M service of that day | Must be clearly documented before surgery begins |
| Decision one day before surgery | Use Modifier 57 | On the E/M visit from the previous day | Do NOT place Modifier 57 on surgery-day visit |
| Decision two or more days before surgery | Use Modifier 57 | On the earlier visit when the decision was made | Surgery-day check-up is included in global package |
| Decision made earlier but patient returns on surgery day | Do NOT use Modifier 57 on surgery day | Modifier 57 must stay on the original decision visit | Many coders make this mistake; leads to denials |
| Decision during emergency evaluation | Use Modifier 57 | On the E/M visit right before surgery | Note must show urgent clinical need and exact timing |
| Decision based only on test results without E/M | Modifier 57 not allowed | No placement | CMS requires E/M evaluation for Modifier 57 |
| Decision made by another provider | Modifier 57 depends on which provider makes final decision | On the provider who made the decision | Transfer-of-care notes must show responsibility |
| Minor surgery (0-day or 10-day global) | Do NOT use Modifier 57 | Not applicable | Use Modifier 25 instead |
Understanding the 0-Day, 10-Day, and 90-Day Global Periods With Modifier 57
The global period is the number of days after a surgery during which normal follow-up care is included in the surgery payment. These days are set by CMS and used by all insurance companies. To use Modifier 57 correctly, you must understand the difference between 0-day , 10-day , and 90-day global periods. Modifier 57 is only used with 90-day global surgeries , which are called major procedures .
A 0-day global period means the surgery includes only the care done on the same day. Any visit before or after the surgery can be billed separately. Because the surgery is minor, Modifier 57 is never used. If there is an E/M visit on the same day as the procedure, you normally use Modifier 25 , not 57, because the decision for minor procedures follows different rules.
A 10-day global period means the surgery includes the day of the procedure and the following 10 days of routine follow-up care. These surgeries are also minor. They do not qualify for Modifier 57 because they are not major surgeries. Again, you use Modifier 25 if an E/M service is significant and separate.
A 90-day global period means the surgery includes the day of the procedure and the following 90 days of standard postoperative care. These are major surgeries. Examples include spine surgery, joint replacement, major abdominal surgery, cardiac surgery, and neurosurgery. Modifier 57 applies only to this category. This is because the “decision for surgery” can be billed as a separate E/M service only for major surgeries.
To use Modifier 57 with a 90-day global procedure, the medical record must show that the doctor made the final decision for surgery on the same day or one day before the surgery. The timing must match the date of the E/M note. The E/M service must have full documentation: history, exam, medical decision-making, imaging review, and clear explanation of why surgery is necessary.
If a surgery has a 90-day global period but the decision for surgery was made several days earlier, Modifier 57 must be added to that earlier visit. The surgery-day visit cannot get Modifier 57, even if the doctor repeats the assessment. This mistake is one of the biggest reasons for denials.
Insurance companies also check for inconsistencies between the global period and modifier usage. If you place Modifier 57 on a procedure that has a 0-day or 10-day global period, they will deny the claim immediately. They know Modifier 57 is only valid for major surgeries.
Clear understanding of global periods helps coders avoid costly errors. It ensures correct billing, prevents loss of revenue, and keeps the practice compliant. Knowing the difference between 0-day, 10-day, and 90-day global periods is the foundation for using Modifier 57 correctly and safely.
How to Read an Operative Note to Confirm Modifier 57 Eligibility
To use Modifier 57 correctly, you must understand how to read an operative note . The operative note is the official report written by the surgeon after surgery. It explains what happened during the procedure, why the surgery was needed, and what the surgeon found inside the body. Many coders think the operative note only helps with procedure coding, but it is also extremely important for confirming whether Modifier 57 was used correctly.
The first thing to look at in an operative note is the Indication for Surgery section. This part explains why surgery was needed. It should match the E and M visit that contains Modifier 57. If the E and M note says the decision for surgery happened on a certain day, but the operative note says the patient had a long-standing plan for surgery, then something is wrong. This mismatch can cause denials because it shows the timing was not correct.
Next, check the Preoperative Diagnosis . This diagnosis must match the diagnosis used in the E and M visit where Modifier 57 was applied. If the diagnosis is different, insurance may think the decision was not made during that E and M visit. For example, if the E and M note says “acute abdomen” but the operative note says “chronic abdominal pain,” the payer may question the accuracy of the decision timing.
Then review the Timeline Information . Many operative notes include the time the patient entered the operating room and the time the surgery started. These timestamps help auditors see if the E and M visit happened before surgery. If the documentation shows the E and M note was signed after the patient was already in the operating room, then Modifier 57 cannot be used. The decision must always happen before surgery begins.
Another important part is the History and Exam Summary in the operative note. Even though this section is short, it often confirms details of the E and M visit. If the surgeon writes that the patient arrived for emergency evaluation and surgery was required immediately, it supports Modifier 57. But if the surgeon writes that the patient was already scheduled for surgery days earlier, it proves Modifier 57 should not be used on the surgery day.
Also check the Consent Section . If the operative note says consent was obtained days before the surgery, that means the decision for surgery was made earlier. Modifier 57 must be applied to that earlier visit, not the visit on the surgery day. If the consent date does not match the E and M date, auditors will deny the claim.
The Findings section shows what the surgeon saw during the procedure. This section must support the medical necessity described in the E and M note. If the findings show a severe condition that matches the assessment in the E and M service, it strengthens the claim. If the findings are mild and do not match the severity described earlier, insurance may question the need for a decision-for-surgery E and M service.
Reading the operative note carefully helps coders confirm that all documentation aligns. When the E and M visit, diagnosis, consent date, and surgical findings all match, Modifier 57 is fully supported. This reduces audit risk and ensures clean claims
The Difference Between Modifier 57 and Modifier 25 in High-Risk Claims
Modifier 57 and Modifier 25 are often confused, but they have very different rules. Both can appear on an E/M visit, but they serve different purposes. Modifier 57 is used when the doctor makes a decision for a major surgery . Modifier 25 is used when the doctor
performs an E/M service on the same day as a minor procedure and it is significant and separate. Understanding the difference is critical for coding high-risk claims correctly.
Modifier 57 applies only to major procedures with a 90-day global period . This includes surgeries like spine operations, joint replacements, and major abdominal surgeries. Modifier 25, on the other hand, is used for minor procedures that have 0-day or 10-day global periods. If you use Modifier 57 on a minor procedure, the claim will be denied. Similarly, using Modifier 25 on a major surgery E/M decision visit is incorrect.
In high-risk claims, the distinction becomes more critical. For example, a patient comes with severe abdominal pain. The doctor decides on a major surgery , such as a colectomy. The E/M visit leading to that decision should have Modifier 57. If the doctor performs a small procedure, like a skin biopsy on the same day, Modifier 25 can be used for the E/M service related to that minor procedure, but not for the surgical decision.
Documentation is the key to distinguishing the two. Modifier 57 requires clear documentation that the final surgical decision was made . The note should include history, exam, lab or imaging review, and the reasoning behind the surgery. Modifier 25 requires documentation of a significant, separately identifiable E/M service , unrelated to the minor procedure performed.
Timing also plays a role. Modifier 57 must be applied on the visit where the decision for surgery is made, usually the same day or one day before the surgery . Modifier 25 applies when an E/M service is performed on the same day as the minor procedure , but it is separate from that procedure. Payers carefully review these timing rules to prevent incorrect payment.
Auditors look for errors in both modifiers. Common mistakes include applying Modifier 57 to minor procedures, or applying Modifier 25 to major surgeries. Such mistakes lead to claim denials, delayed payment, and potential audit issues. Following the rules correctly helps clinics remain compliant and reduces financial risk.
Understanding these differences also helps in coding high-risk or emergency cases , where quick decisions may be needed. Proper application ensures the E/M visit gets paid separately when it deserves, while also keeping the surgical procedure in the global period.
Correct usage of Modifier 57 and 25 ensures clean claims, proper reimbursement, and audit-proof documentation . This distinction is one of the most important technical details for coders working with surgical procedures, high-risk cases, and major claims.
Advanced Scenarios: When Modifier 57 Applies Without a Physical Exam
Modifier 57 is usually applied during an E/M visit with a full history and physical exam . However, there are advanced scenarios where the final decision for surgery can be documented without a full physical exam. Understanding these scenarios is critical for coders and auditors.
One scenario is when surgery is decided based on prior records and imaging . For example, a patient may have recent lab tests, MRI scans, or CT scans that clearly show a surgical need. If the doctor reviews these records during the visit and documents a final decision for surgery, Modifier 57 can be applied, even if a detailed physical exam is not performed. Documentation must clearly note the evaluation of these records.
Another situation is telemedicine or virtual visits . During the COVID-19 pandemic, many surgeons made surgical decisions through secure video calls. If the doctor reviews history, symptoms, and imaging and makes the final decision, Modifier 57 is valid. Coders must ensure the note clearly states “Decision for surgery made during telemedicine evaluation.” Emergency and trauma cases often require rapid decisions. A patient may arrive with life-threatening injuries . The doctor may decide to operate immediately. Even if a complete exam is not possible due to urgency, Modifier 57 can be applied as long as documentation shows a clear surgical decision. Time, patient condition, and rationale must be documented.
For repeat visits, sometimes the patient’s condition worsens quickly. If a prior exam exists, the doctor may use the existing exam to confirm the need for surgery and apply Modifier 57. The key is documentation : the note must clearly indicate the surgical decision and the reasoning behind it.
Coders must also understand payer rules. Some insurance companies require at least a brief exam note or reference to prior records. Others are more flexible, especially for emergency cases. Always check payer guidelines before final submission.
Incorrect usage occurs when the decision is assumed but not documented. For example, a note that simply states “Patient requires surgery” without explanation is not enough. The documentation must show why surgery is required and that the doctor made the final decision during that visit.
Advanced scenarios without a physical exam emphasize the importance of history, imaging, labs, and clinical reasoning . Proper documentation ensures Modifier 57 is supported, prevents claim denials, and maintains compliance with CMS and payer requirements.
Understanding these exceptions is essential for high-level coding. Coders who recognize valid Modifier 57 usage without a full exam can maximize clean claims and avoid costly denials. Hospitals, clinics, and auditors all benefit from clear documentation of these advanced scenarios.
| Scenario | Modifier 57 Usage | Key Documentation Needed | Notes |
| Surgery decision based on prior imaging/labs | Allowed | Clear review of prior results, surgical decision statement | No new physical exam required if records support decision |
| Telemedicine / virtual visit | Allowed | Video visit note, history, symptom review, imaging/lab review, decision for surgery | Must clearly show decision made during virtual visit |
| Emergency / trauma surgery | Allowed | Documentation of patient condition, urgency, rationale, decision | Full physical may not be possible due to critical condition |
| Repeat visit using prior exam | Allowed | Reference prior exam, document worsening or new findings, final decision | Modifier 57 goes on visit where final decision is confirmed |
| Incomplete documentation | Not allowed | Insufficient detail, vague statements | Modifier 57 will be denied if reasoning is unclear |
| Minor procedures | Not allowed | N/A | Use Modifier 25 for minor procedures instead of 57 |
Using Modifier 57 With Consultation Codes and Specialist-to-Specialist Transfers
Modifier 57 can also be used in consultations and specialist-to-specialist transfers , but this is a technical and advanced area. A consult is when a doctor evaluates a patient at the request of another doctor. For example, a primary care doctor may ask a cardiologist to see a patient. If during that consultation the cardiologist makes a decision for major surgery , Modifier 57 can be applied.
For specialist-to-specialist transfers, the same rules apply. A patient may move from one specialist to another before surgery. The doctor who makes the final surgical decision during an E/M visit is the one eligible to use Modifier 57. The earlier specialist or referring doctor does not get Modifier 57 unless they made the final decision themselves.
Documentation is critical. The consult note must clearly show the reason for the consult, the patient’s history, exam, lab and imaging review, and the decision for surgery . Without this documentation, Modifier 57 cannot be applied. Auditors often check that the consult visit is not part of routine referral care but a decision-making encounter .
Timing also matters. If the consult leads directly to the surgical decision on the same day or one day before surgery, Modifier 57 applies. If the consult is done earlier and surgery is decided later by another specialist, the modifier should be applied only on the visit where the final decision is made. Placing Modifier 57 on the wrong visit can cause claim denial.
Payers also require that the consulting physician documents why surgery is needed and that the E/M service is separate from any minor procedures performed. If a minor procedure is done during the consult, use Modifier 25 for that E/M service, not Modifier 57. Modifier 57 must always represent major surgery decision-making .
These advanced scenarios demonstrate that Modifier 57 is not limited to one practice type or provider. Hospitals, specialty clinics, and multi-provider care teams must carefully track who makes the surgical decision, on what date, and with what documentation. Clear coordination between providers avoids denials and ensures correct reimbursement.
Proper use of Modifier 57 in consults and transfers improves billing accuracy, reduces audit risk, and maximizes reimbursement for cognitive decision-making work done before surgery. Coders must always confirm documentation, timing, and global period applicability to use Modifier 57 correctly in these complex situations.
Master Checklist: A Complete Compliance Framework for Modifier 57
To use Modifier 57 correctly and avoid denials, auditors and coders rely on a clear compliance framework . This checklist ensures that every E/M visit meets CMS rules, payer requirements, and documentation standards for major surgeries.
1. Confirm Surgery Type:
Modifier 57 is only for major procedures with a 90-day global period. Check the CPT code to confirm the surgery qualifies. Do not use Modifier 57 for minor procedures (0-day or 10-day global).
2. Verify Timing:
The final decision for surgery must occur on the same day or one day before surgery. Check timestamps, operative schedule, and consent dates. Place Modifier 57 only on the visit where the decision was made.
3. Documentation of Decision:
The E/M note must clearly state that the final surgical decision was made. Include the patient’s history, physical exam, lab or imaging review, reasoning for surgery, risks, benefits, and treatment alternatives considered.
4. Align Diagnosis:
Ensure the preoperative diagnosis in the E/M note matches the operative diagnosis in the surgical note. Mismatched diagnoses can trigger denials.
5. Distinguish from Minor Procedures:
If an E/M visit includes minor procedures on the same day, use Modifier 25 for those services, not Modifier 57. Modifier 57 applies only to the major surgical decision.
6. Confirm Consult and Specialist Roles:
If the visit is a consult or part of a specialist transfer, verify that this provider made the final surgical decision . Earlier specialists or referring providers do not qualify.
7. Special Scenarios:
For telemedicine, urgent, or emergency cases, document clearly how the decision was made. Even without a full exam, include rationale, patient condition, and supporting records.
8. Operative Note Cross-Check:
Verify the operative note supports the E/M documentation. Check indication for surgery, findings, timeline, and consent. Any mismatch may result in claim denial.
9. Audit Readiness:
Ensure every note is complete, dated, and signed. Keep records organized for payer or CMS audits. Missing elements like timing, diagnosis, or decision rationale increase risk.
10. Coding Accuracy:
Use the correct CPT code for the E/M visit, attach Modifier 57 properly, and confirm global period alignment. Double-check against payer rules and Medicare guidelines.
Following this 10-step checklist ensures that Modifier 57 claims are compliant, reduces denials, and protects revenue. Coders and providers should review each visit carefully and document every element. Proper use of Modifier 57 rewards practices with clean claims, faster reimbursement, and audit-proof documentation .
This checklist also works as training material for new medical coders , a standard operating procedure for clinics, and a reference during audits. By following these steps, practices ensure maximum compliance and financial protection when billing for major surgery decisions.
How MZ Medical Billing Supports Modifier 57 Compliance and Surgical Billing
Using Modifier 57 correctly requires attention to CPT coding, documentation, timing, and payer rules. MZ Medical Billing’s certified team handles each step of surgical billing, from reviewing E/M notes for complete history, exam, and decision documentation to cross-checking operative notes and consent forms. Our specialists work to align claims with CMS and commercial payer requirements.
We support hospitals, specialty clinics, and multi-provider practices in:
- Revenue Cycle Oversight: Reviewing claims, spotting potential denials, and tracking accounts receivable.
- Denial Prevention: Identifying errors in coding, timing, or documentation before submission.
- Specialty Surgical Billing: Orthopedics, neurosurgery, cardiology, and other major surgery areas.
- Telehealth and Emergency Consultations: Billing properly when surgical decisions are made remotely or in urgent situations.
Modifier 57 separates the final decision visit from the global surgical package. Applying it correctly protects the E/M service from denials and secures appropriate reimbursement. By following documentation, timing, and coding rules, practices reduce claim errors and recover revenue that might otherwise be lost.
MZ Medical Billing can audit surgical billing workflows, check Modifier 57 usage, review global period alignment, and highlight claims at risk. Providers gain a clear view of where adjustments are needed and can act to prevent denials and delays.
