Modifier 57 for Fracture Care: When the First Visit Is Separately Payable

Direct answer

Append modifier 57 to the E/M visit when that visit included the initial decision to proceed with a major procedure (one with a 90 day global period) performed that day or the next day. Most definitive fracture care codes, operative and closed treatment alike, carry 90 day global periods, so the visit where fracture care is decided and initiated takes modifier 57 and keeps its full value. Minor procedures (0 or 10 day globals) use modifier 25 logic instead.

Why the modifier exists

The global surgical package for a major procedure includes the preoperative visit the day of and the day before surgery. Without a modifier, the visit where you evaluated the injury and decided on treatment would be absorbed into the fracture care payment. Modifier 57 marks that visit as the decision for surgery, which the package explicitly does not include, so the E/M pays in full alongside the fracture code.

It applies to closed treatment too

This is the part orthopaedic surgeons miss most: closed treatment codes with 90 day globals (for example closed treatment of a distal radius fracture) are major procedures for this rule. The visit where you evaluate the fracture, decide on nonoperative definitive care, and initiate it takes modifier 57 exactly as an operative decision would.

Documentation that supports modifier 57: "Displaced distal radius fracture evaluated today. After discussion of operative and nonoperative options, the decision was made to proceed with closed reduction and casting as definitive fracture care, performed today." Decision documented, timing documented, definitive care initiated.

57 versus 25

Modifier 57 belongs to major procedures (90 day globals) decided the day of or the day before. Modifier 25 belongs to minor procedures (0 or 10 day globals) such as injections and simple laceration repairs. Using 25 where 57 belongs, or either where no separate decision or work exists, are the two audit patterns to avoid.

After the decision

Once the fracture code is reported, its 90 day global period begins: routine fracture follow ups inside it are 99024, and unrelated problems seen during it take modifier 24. The end of the global period, day 91 onward, returns everything to ordinary visit coding.

Check it against your own note

The Fracture Calculator prices definitive fracture care against visit by visit coding for your specific fracture, and the E/M Coding Assistant detects the major surgery decision in your note and applies modifier 57 with the reasoning written out.