What modifier is used when an E.D. physician decides that a surgical procedure is necessary?

The correct modifier to use when an Emergency Department (E.D.) physician determines that a surgical procedure is necessary is the -57 modifier. This modifier indicates that the decision for surgery was made during an evaluation and management (E/M) service on the same day. It is essential in situations where medical necessity is established through the E/M service and leads to an urgent surgical intervention.

The application of the -57 modifier helps clarify billing for the E/M service as it signals to the payer that this visit was pivotal in decision-making for subsequent surgical procedures. Without this modifier, the evaluation done prior to surgery might not be appropriately recognized as part of the surgical decision-making process.

Modifiers such as -54, -56, and -58 have different implications and should be used in specific circumstances that do not apply here. For instance, -54 denotes a surgical care only scenario, -56 refers to preoperative management, and -58 indicates a staged or related procedure during the postoperative period. In this context, since the focus is on the necessity of surgery determined on the same day as the evaluation, the -57 modifier is the most appropriate choice.