Stay Alert:

Modifier 57 is still Applicable

Stay Alert: Modifier 57 is still Applicable

Suzanne Leder
M. Phil., CPC, COBGC
Stay Alert: Modifier 57 is still Applicable

Medicare no longer accepts consult codes,

but you can still apply modifier 57.
Stay Alert: Modifier 57 is still Applicable

Append modifier 57 to non-consult inpatient

E/M code that the documentation supports.
Stay Alert: Modifier 57 is still Applicable

Add the modifier to E/M

code to report an EM in
addition to the major surgery
performed later on the day
of the inpatient consult.
(In such cases report 49000 with Modifier 57)
Stay Alert: Modifier 57 is still Applicable

The E/M code you choose

depends on circumstances
specific to the visit
(whether first or second)
Stay Alert: Modifier 57 is still Applicable

For First visit code –

99221 (Initial hospital care, per day, for the E/M of

a patient, which requires these 3 key components: a
detailed history; a detailed examination; and MDM
that is straightforward or of low complexity …)
Stay Alert: Modifier 57 is still Applicable

Don’t forget to append

‘Modifier AI’ if the Ob-
Gyn is the Principal
Physician
Stay Alert: Modifier 57 is still Applicable

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