Key CPT Codes
| CPT | Descriptor | wRVU | Medicare estimate | Global |
|---|---|---|---|---|
| 99214 | Established patient office visit level 4 | 1.92 | $135.61 | 0 |
| 99223 | Initial hospital care, high complexity | 3.5 | $156.32 | 0 |
| 99291 | Critical care, first 30-74 min | 4.5 | $308.96 | 0 |
| 44970 | Laparoscopy, surgical, appendectomy | 9.21 | $578.17 | 90 |
| 47562 | Laparoscopy, surgical; cholecystectomy | 10.21 | $631.95 | 90 |
| 49000 | Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) | 12.23 | $728.81 | 90 |
Coding Decision Points
- Modifier 57 belongs on the E/M service, not the procedure.
- It applies to the decision for major surgery, typically 90-day global procedures.
- Document the assessment, risk discussion, and decision to proceed urgently or emergently.
Common Documentation Gaps
The E/M note should make the decision for surgery explicit, separate from routine preoperative H&P work, and tied to the major procedure timing.
FAQ
What does modifier 57 mean?
It identifies an E/M service that resulted in the decision for major surgery.
Is modifier 57 the same as modifier 25?
No. Modifier 25 is for a significant separately identifiable E/M service; modifier 57 is the decision for major surgery.