Wiki Help with deciding if a modifier needs to be added for a PCP f/u after surgery

[Carroll1220]

Do you add a modifer 55 to 99214 when the PCP does a f/u?

Good evening!

I was wondering if I would need to add a modifier 55 to 99214 when a patient followed up with her PCP after a cholecystectomy. The PCP did not have a transfer of care. He just encourages his patients to see him any time they have a hospital visit so he can review things with them.

When I looked this up on CMS.gov, they state:
Exceptions to the Use of Modifiers ?-54? and ?-55?
Where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate E/M code. No modifiers are necessary on the claim.

So would I or would I not add a modifier? The patient is following up with the surgical office, too.

Thank you so much for your help! It is so appreciated!

Noelle

 

[bigredcag]

If the PCP is a different specialty then you would not use any modifier. You are correct there was not a transfer of care so the use of 54/55 is inappropriate. hope this helps
chris

 

[mitchellde]

55 modifier cannot be added to an E&M code. To bill for surgical follow up if you are not the surgeon, you must have a transfer of care from the surgeon in the patient chart and you bill with the procedure code the surgeon used with the 55 modifier. If the surgeon does not transfer the post op care to your provider then you cannot bill the visits to the payer