Ophthalmic Coding Specialist Practice Test

What does the modifier -57 indicate?

1. Unplanned return to OR

2. Decision for surgery

3. Unrelated service during postoperative period

4. Bilateral procedure

The correct answer is: Decision for surgery

The modifier -57 is used in the context of surgical coding to indicate that a decision for surgery was made during a visit or examination that led to a surgical procedure being performed. This modifier is crucial because it helps differentiate between an evaluation and management service that is part of the surgical decision and one that is unrelated. By appending modifier -57 to the relevant code, it signifies that the visit conducted on the same day as or the day prior to the surgery included the critical decision that the patient should undergo surgery. This distinction is important for correct billing and ensures that the healthcare provider is reimbursed appropriately for the services rendered during that encounter. Understanding the other choices helps clarify why they do not apply in this situation. An unplanned return to the operating room reflects a different scenario where additional surgery or procedures are required due to unforeseen complications. An unrelated service during the postoperative period refers to services provided that do not relate to the surgical procedure performed, which again does not pertain to the decision made prior to surgery. Lastly, a bilateral procedure modifier specifically indicates that a procedure was performed on both sides of the body, which is unrelated to the surgical decision-making aspect captured by modifier -57. Thus, the correct choice highlights the function of the modifier in relation to