Practice Management Alert

Question: Because we are in a small, rural town, our physician sends many patients to a nearby city for surgical treatment and then sees them here in our office for post-op care so the patient does not need to travel back to the city for a short follow-up appointment. The physician says we should just consider these visits a patient courtesy, but I think there must be a way for us to bill for the post-op visits. What is the best way to handle this?

Arkansas Subscriber

Answer: If your office can work with the surgeons billing department, you can -- and should -- report the post-op visits your physician is providing

Heres how: CPT codes are broken down into a preop/surgery/post-op split. This means, of the total allowable for the CPT code, a percentage is allocated for preoperative work, a percentage for the surgical portion, and another portion for postoperative work. If the surgeon does not perform all three components, you should not code and bill for the entire (global) fee for a surgical code.

When your physician is performing only a procedures postoperative care, you will append modifier 55 (Postoperative management only) to the same procedure code the surgeon reports for the procedure.

Key: Communication between your physician and the other physician(s) involved in the patients treatment is important for proper billing. If youre reporting the postoperative care using modifier 55, make sure the surgeon who performed the procedure reported his service with modifier 54 (Surgical care only) and indicates the transfer of care in box 19 of the claim. Otherwise the payer will deny your claim because it has already reimbursed the surgeon for providing the full care associated with the code.

Alternative: If you are unable to coordinate with the surgeon, you can choose to report an appropriate E/M code whenever your physician sees the patient for postoperative follow-up care, rather than using modifier 55.