Gastroenterology Coding Alert
Take Control Over Your Modifier 54/55 Knowledge
Question: How do I code for a post-op service performed by a different physician? For example, we had an out-of-town patient recently move here, but she had surgery in her previous town. Now she needs post-op care. It looks like I should use modifier 55 to indicate there is a new provider. Is that right? AAPC Forum Participant Answer: Yes, you should use modifier 55 (Postoperative management only) in this situation if the procedure has a global period of 10 or 90 days. There are a few additional considerations to factor into this scenario, though. The surgeon needs to have submitted the surgery claim with modifier 54 (Surgical care only) to avoid getting paid for the bundled postoperative care. That may not have happened in this scenario, especially if the surgeon wasn’t aware that the patient wouldn’t be in town after the procedure. You must work closely with the surgeon and let them know about the situation. The surgeon will then have to send a correction to the overpayment recovery department. Otherwise, the physician taking over the postoperative care will likely be denied when submitting their portion of the care. Additionally, the physician taking over after the surgery needs to see the patient at least once before billing for the postoperative care. However, instead of reporting the day the physician saw the patient, you’ll need to report the date of service (DOS) as the date the surgery took place. The relinquished information belongs in item 19 of the claim form. If the patient has moved a significant distance and the postoperative team is in a different state than the surgery, clearly indicate that to the MAC.
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