Orthopedic Coding Alert

Question: My physician saw a patient, but he was not well practiced at the surgery the patient needed. Therefore, he only assisted in surgery, but provided all the postoperative care. How do I bill for this so that he receives the proper reimbursement?

Ohio Subscriber

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Answer: The key to each surgeon obtaining appropriate reimbursement for his or her services lies in coordinating the coding in advance. If this is done, both surgeons will be reporting the same CPT code for the surgery that was performed, but with different modifiers appended to define each physicians role. The surgeon who performed the surgery on which your doctor assisted should report the surgical procedure code with a -54 modifier (surgical care only). Your physician, if he provides all of the post-discharge postoperative care, should report the surgical procedure CPT code with a -55 modifier (postoperative management only).