Tag Archives: modifier 54
Posted on 08. Dec, 2009 by .
Question: An ophthalmic surgeon performs cataract surgery, and then turns the patient over to the optometrist for postoperative management only. How should I code between the two providers? Do I need a modifier?
Answer: If the ophthalmic surgeon turns the patient over to the optometrist for all 90 days of postoperative care, the optometrist will report 66984 with modifier 55 (Postoperative management only) appended for 90 days of service. If the surgeon turns over care to the optometrist immediately, the optometrist is responsible for postoperative management for the whole 90 days, regardless of when he first sees the patient.
Split care: If the ophthalmic surgeon does not transfer care immediately, he may report 66984-55 for however many days he remains responsible for postoperative management. The optometrist then reports 66984-55 for however many days remain in the 90-day global period. The ophthalmic surgeon should append modifier 54 (Surgical care only) to the cataract surgery code (for example, 66984, Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).
Posted on 12. Oct, 2009 by .
No maybes here: Answer this question wrong and you will code incorrectly.
When your ED physician performs fracture care for a patient, be ready to pounce on evidence of manipulation, as CPT often breaks fracture care codes along the manipulation line.
The $kinny: Let’s say the physician performs closed treatment on a fractured collarbone; if she uses manipulation, the service is worth about $106 more than a nonmanipulation encounter.
Use this FAQ to successfully manipulate both types of fracture care codes — and ethically add to the practice’s bottom line.
Posted on 24. Sep, 2009 by .
Question: A 30-year-old female presents to a rural ED with several injuries after the all-terrain vehicle she was driving overturned. During a level-five ED E/M service, the physician diagnoses a fractured metacarpal shaft in her left hand and a fractured left femur. The ED physician provides closed manipulative treatment for each fracture. How should I code this scenario?
Answer: Report the most severe fracture first, and make sure that you append a surgical modifier to the treatment codes. To make things easier, we’ll list the appropriate CPT codes first, then the ICD-9 codes.
CPT coding: On the claim, report the following:
• 27502 (Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction) for the femur treatment
• 26605 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) for the metacarpal treatment
• modifier 54 (Surgical care only) appended to 27502 and 26600 to show that you are coding only for the fracture treatment (If the ED physician is, for some reason, providing all the follow-up care for the patient, then you can leave modifier 54 off the claim).