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Only append modifier 57 to an office visit E/M code when the decision for surgery visit occurs the day of or the day before a 90-day global major operation. Should I append modifier 57, Decision for surgery, to an office evaluation and management (E/M) service if the visit occurred two months before the scheduled surgery? Surgeons can verify their Medicare enrollment details and specialty status using the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). For each of these practice foci, the surgeon would most likely choose general surgery or surgical oncology. For example, Medicare has no specialty designation for breast surgery, bariatric surgery, or hepatobiliary surgery. Also, be aware that Medicare does not have a designation for every specialty. The designation should represent most of the surgeon’s caseload. Keep in mind that a surgeon does not need to be board certified in a specialty to designate a specialty for Medicare. It is important that all surgeons know their specialty designation with Medicare and other payors. However, if the surgeon’s specialty designation is general surgery (even though the surgeon primarily performs colon and rectal procedures), then the patient would be considered established. The colorectal surgeon would report the patient as a new patient if the surgeon’s specialty designation in the Medicare/payor file is colorectal surgery. If a general surgeon in the practice performs a hernia repair on a patient and, six months later, a colorectal surgeon in the practice sees a patient with complaints of bright red blood in stool, is the patient new or established for the colorectal surgeon? My group practice has both general surgeons and colorectal surgeons. This column responds to several frequently asked questions posed to the American College of Surgeons’ Coding Hotline. Assigning the correct Current Procedural Terminology (CPT)* code for procedures and services is an important aspect of surgical practice.