Rely On 54 for This Out-of-Town Surgery
Question: I live in a region famous for mountain biking, and a provider in my practice saw a patient who fell while biking. The patient suffered a right ulnar shaft fracture, and the surgeon performed an open reduction and internal fixation of the shaft. The surgeon noted that the patient was returning home to Pennsylvania as soon as possible and will receive the appropriate postoperative care from a local surgeon once home. The documentation clearly states that another surgeon will handle the post-op care. How should I code this to show that the surgical and postoperative services are separate? Vermont Subscriber Answer: On this claim, you’ll report 25545 (Open treatment of ulnar shaft fracture, includes internal fixation, when performed) with modifiers 54 (Surgical care only) and RT (Right side) appended. Situations like this are a perfect example of the appropriate use of modifier 54, because the patient is seeking care in multiple places due to being a visitor to the area where the injury’s sustained and the surgery performed. Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC
