Wiki Billing excision and repair different days, different provider, same practice.

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SUN1633

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We have a plastic surgeon in our practice who does closures for other providers sometimes. In the scenario in question, provider A did an excision of malignant lesion face on Monday. Set for planned closure with provider B the very next day. Provider B determined simple repair. Is this billable, or would it be non-billable as included in excision, even if done on a different day by different provider? Thanks in advance.
 
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That seems certainly unusual from anything I have come across. If the providers are in different practices, then both should be paid for the services performed.
I would think the best way to do so is:
Dr. A bills excision with -52 (since closure would be included, but not done)
Dr. B bills a repair
Whether or not this will fly with the insurance carrier is another matter.

I suppose another alternative (but would would advise to obtain legal guidance on this) is for Dr. A to bill the full fee and then pay Dr. B some set rate. This type of arrangement is sometimes done in OB (especially small practices) when the OB cannot be on call 24/7. They either make a reciprocal arrangement with another small practice, or pay another physician or practice to deliver for their patients.

Would love to hear any other ideas.
 
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ASH527 said:
I would bill the 2 nd provider with the closure code and modifier 58.
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If the providers are in different practices, I don't think the -58 on the repair by Dr. B is correct.
-58 Staged or related procedure or service by the same physician during the postoperative period.
It was staged, but not the same physician.
 
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ASH527 said:
What if u use modifier 78. Related procedure.
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Nope - read the full description.
-78 Unplanned return to the operating or procedure room, by the same physician, following an initial procedure for a related procedure during the post-operative period
Again, "same physician". "Unplanned" doesn't apply either. I would also doubt the patient was taken to an operating or procedure room (can't be a minor procedure room in your office - has to be OR or a true surgical suite like endoscopy suite, cardiac cath suite, etc.)
It's certainly something I've never seen before, but unless someone comes up with a modifier I am not aware of, if you are billing as my original recommendation:
Dr. A excision with -52
Dr. B repair (no modifier).
 
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WAIT - I just realized in the header, it says different physician, SAME PRACTICE. I kept reading the question itself, not the header.
In that situation, since it's the same practice, my arguments about the modifiers -58 and -78 same physician do not apply. For group practices, basically when something states same provider, it means anyone of the same specialty in the same group.
So, I change my original answer and I think the most accurate description is simply the excision without a modifier. Your practice is providing the complete service, just happens to be completed on the subsequent day. If your practice tracks that kind of stuff, you may want to come up with an internal (not billed to insurance) code to demonstrate that service provided by Dr. B.
 
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