Wiki Mod 54 and 55 clarification

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pochranek

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I have a physician who did a procedure (with 90 day global) for SURGICAL CARE ONLY. We used modifier 54. His partner in the same practice is doing only the post op. The patient was seen 10 days later and I am being told to bill the same surgical codes using modifer 55. Any future visits will be billed with the 99024 post op visit.

Is this correct?

thank you for you help!
 
Are both physician in same specialty?

If both physicians are in the same practice AND the same specialty, then you just code the surgery to the one who performed the operation and all follow-up care is covered in the global period.

If Surgeon A performs the surgery and Physician B (same practice, but DIFFERENT specialty) handles the follow-up. Then Surgeon A codes the surgery with a -54 modifier; Physician B codes the surgery with a -55 modifier for the first post-op visit (and uses 99204 for any additional follow-up visits).

NOTE: if the second scenario describes your case, there must a written formal transfer of care from Surgeon A to Physician B.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
Thank you very much for clearing up the confusion for me! I am a new coder and in reading the modifiers it seemed very convoluted.
 
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