Global Surgical Period CPT and modifier 25 and 57

Modifier 25 used when seperately identifiable E/M service is rendered on the same day of the procedure or other services. If a patient comes with wound in the hand and the physician evaluates the patient and documents the assessment as hand laceration then this is an an E/M service. The physician then performs an wound closure using say staples. Here wound closure is another seperate procedure or service provided by the physician on the same day. Hence modifier 25 is required. If on the other hand, a patient arrives with chest pain and the diagnosis is myocardial infarction, and the physician performes a CABG this wound require the use of modifier 57.

CPT global period includes one related E/M encounter prior to or on the date of procedure resulting in the decision for surgery. The E/M level will require modifier 57 (Decision for Surgery).

The choice of modifiers 57 or 25 depends on the global period of the procedures. Global period for CPT procedures differ from procedure to procedure.

57 modifier is assigned for major surgical procedures or procedures with 90 day global period. If the global period of the procedure is not 90 days or the procedure is not a major surgical procedure then modifier 25 should be used. The global period of major surgical procedures begin one day prior to actual procedure.

The global package of CPT procedure codes is divided into three parts pre-operative services, intra-operative services, and post-operative care. The post operative care includes all related followup visits during the global period.


54 Surgical care only is used to report intra-operative services.
55 Postoperative Management is used to indicate postoperative services.

There are some procedure that can be performed in stages rather the same procedure be performed at once. Modifier 58 should be appened to a staged procedure done by the same physician during the global period of the original procedure.

58 Staged or related procedure or service by same physician during the postoperatuive period.

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