Wiki Help reporting co managed care!

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cherylbr

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Our physician (Provider A) is providing surgery and 45 days of post operative care. He then is transferring care to another provider (Provider B).

:confused::confused::confused:
When reporting for our physician (Provider A) I will report the claim for surgery with modifier 54 on the first line.

When reporting for our physician (Provider A) I will report the claim for post op care on a second line with the proper date span on line 2 of the claim with modifier 55.

Here is my question:

Must I wait till the ending date of our post operative care provided by our physician (Provider A) is complete before submitting my claim? And, can I send two separate claims for the surgery and post operative care or must the claim have both items reported on the same claim which would mean Provider A should wait to submit his claim till he has transferred care to Provider B?

Your help is greatly appreciated!
 
Most carriers allow you to submit for the post op care the first day you see the pt. Others require you to wait until the post op is finished before you can file for that aspect of the services.

Provider B can't file for their portion of post op until after they've actually seen the pt for the first post op visit they do.

Question for you: Why isn't your doctor "A" releasing the pt sooner than 45 days post op? Assuming this is for cataract surgery, in the majority of cases, unless there's been a complication, the patients are stable by the end of 3-4 weeks.

Being an optometrist who has done hundreds of post ops starting at day 1, I would be somewhat insulted that the surgeon didn't have faith in my abilities to provide the necessary care for these patients. IMHO, what your doctor is offering the "B" providers isn't really supporting true comanaged care. I know many ODs who wouldn't refer to a surgeon who didn't respect their professional abilities.

Tom Cheezum, O.D., CPC, COPC
 
I am not sure what the circumstance is for the of 45 days of post op care. However, thank you very much for this information!
 
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