When an outpatient E/M code is billed with the -57 modifier, what does that signify?

When an outpatient E/M code is billed with the -57 modifier, what does that signify?

• A. Decision for surgery
• B. Routine follow-up
• C. Administrative update
• D. Subsequent hospital visit

Answer: (A)

Modifier -57 is used when an outpatient evaluation and management service results in a decision to perform surgery. It signals that the visit’s purpose was to decide on a surgical procedure, and a surgery is scheduled or performed soon after, with the operation reported separately. This distinguishes the encounter from routine follow-ups or administrative updates, which do not reflect a surgical decision. The other options describe circumstances that do not involve deciding on a surgical procedure during the visit.

Modifier -57 is used when an outpatient evaluation and management service results in a decision to perform surgery. It signals that the visit’s purpose was to decide on a surgical procedure, and a surgery is scheduled or performed soon after, with the operation reported separately. This distinguishes the encounter from routine follow-ups or administrative updates, which do not reflect a surgical decision. The other options describe circumstances that do not involve deciding on a surgical procedure during the visit.