Minor & Major Difference between 25 and 57 modifier

We know that their are set of modifiers used for E/M codes for any related or unrelated services performed on the same date of service (DOS). But still many medical coders are not aware when to use these set of modifiers depending on the procedures (major or minor) performed on same DOS.

Today we will learn when to use the modifier 25 and modifier 57 when a minor or major exam is performed with E/M visit. Before going ahead let us see the description of both modifiers below.

25 modifier– significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service.

57 modifier – Decision for surgery (assigned with E/M service leads to the decision to perform surgery)

When to assign 25 and 57 modifier based on global period

25 modifier should be assigned to E/M when a exam or procedure performed has 0 or 10 days global period. This modifier should be given when X-ray, ultrasound, MRI, CT or any minor surgery performed along with a E/M visit on same day has global period 0 to 10 days.

For example,

1) If  E/M (CPT code 99214) visit is done and same day an exam with CPT code 17000 is performed. In this exam, CPT code  17000 has global period of 10 days (shown in below image) hence the E/M visit should be assigned with 25 modifier  (99214-25).

2) If the same E/M visit is done along with a major procedure CPT code 59820 (care for miscarriage) is performed, since the code 59820 has global period of 90 days (shown in below image) 57 modifier will be assigned to E/M visit (99214-57) since a major surgery is done on the same day.

3) If both minor and major surgical procedures are performed on same day with the E/M visit code then we can assign both modifiers to get paid for all the services done on that DOS (99214-25,57)

How calculate Global period for any CPT code

Step 1

Visit the link  https://palmettogba.com/palmetto/rr.nsf/DID/LSR6L6TMZC and you will get below window to search CPT code

Step 2

Now search for any CPT code like 17000 and you can see the number of global days (10 days) as shown below. The results will be instant and you can easily find the global period days for any cpt code.

Now, again if we search another CPT code 59820, you will get global period of 90 days as shown below, depending of the minor and major procedures the global period days will be shown here, which will help in assigning the 25 and 57 modifier to E/M CPT code.