Reserve Modifier 55 for Post-Op Package
Posted on 16. Jul, 2012 by dchandhok in Coding Challenge
Question: Would you please explain when we should use modifier 55? I am not clear on what “management” means.
If another otolaryngologist, not the physician who performed the surgery, sees a post-op patient and admits him to the hospital during the 42-day global period, is modifier 55 appropriate?
Answer: You should use modifier 55 (Postoperative management only) when your otolaryngologist assumes all of a patient’s postoperative care. For instance, if a patient moves after surgery or returns to his local otolaryngologist for postoperative care after a distant otolaryngologist performs the surgery (such as a neck surgery performed at a distant university medical center), you should claim the postoperative component with modifier 55.
| Fast Coder Not sure which modifier to apply? Boost your modifier compliance while working faster with Fast Coder. Click here to buy. |
Nitty-gritty: Modifier 55 actually goes on the surgery code. Suppose a Chicago otolaryngologist performs a mastoidectomy (69501, Transmastoid antrotomy [simple mastoidectomy]) on a patient. The patient, who lives two hours away, chooses to see his local otolaryngologist for all postoperative care. The physician who performed the surgery should claim the surgical care only with 69501-54 (Surgical care only). To bill for the mastoidectomy’s postoperative component, the local otolaryngologist should report 69501-55. There has to be a formal transfer of care from the surgeon to the otolaryngologist for the post op care and the date of that transfer goes in box 19 on the CMS1500 form. Without showing the formal transfer of care, there will be reimbursement problems when you use modifiers 54 and 55.
The situation you describe does not require a modifier. First, modifier 55 does not apply because the otolaryngologist...
- Free updates on CPT, ICD-9, HCPCS, Medicare, NCCI edits, and ICD-10.
- Discounts on 3rd party offers
Loading ...