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Urology Coding Alert

Appending Modifiers 54 and 55 Takes Great 'Coordination'

Published on Sun Jun 14, 2009

Tip: If the other physician involved is not coding correctly, youre out of luck. Surgical co-management of a patients problem takes more than just physician coordination. If you and the other surgeons coder are not on the same page, both physicians could lose out on reimbursement. Get your facts straight on when you can apply modifiers 54 (Surgical care only) and 55 (Postoperative management only) with these expert tips. Look at the Procedure Puzzle Pieces CPT codes are broken down into a pre-op/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 your urologist does not perform all three components, you should not code and bill for the entire (global) fee for a surgical code. How it works: You should append modifier 54 to a surgical procedure code when [...]
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