Largo, FL
Best answers
Does the provider have to document the other physicians name in his op report when he is using the modifier 54 or 55? I can't seem to find any information regarding this. Any help and resources in reference to this would be greatly appreciated. :)
I can't give you a reference, but having done comanaged care for many years, I can tell you that we always mentioned the other comanaging providers name in our reports.

There was also a form the surgeon used when sending the patient back for post op care which both he and the patient signed which listed my name as the doctor doing the post op care. The form basically stated that the surgeon was releasing the patient to me for post op and the patient was consenting to that being done. When I saw the patient, I would generate a report of my findings which went back to the surgeon.

If you don't have the paperwork showing transition of care or any reports from the provider of the post op care going back to the surgeon, it doesn't meet the criteria for comanagement.

Tom Cheezum, O.D., CPC
I just came across this post and was wondering if you had any tips as to how to avoid cataract co-management denials? Every time one is submitted, insurance companies, no matter who it is, deny either the surgical care or post-operative care claim as a duplicate. I recently appealed a denial for the surgical portion and that appeal was denied saying it has been processed correctly :rolleyes: but they paid the $1.15 for post op care.

I'm submitting with the same CPT code, same date of service, 54 for the surgical portion, 55 for the post op portion (a note stating assumed/relinquished dates of care and number of days total), different fee amounts and it's denied every single time.