Wiki Modifier 55-I have a patient

[maryawinfield04]

I have a patient who had surgery with a different provider but my provider performed the post-op care. I appended a -54 modifier to the post-op visit
(99024) but i'm getting a rejection that modifier -54 isn't valid to use with post op (99024). Can anyone let me know if this is a true statement?

Thanks

 

[mitchellde]

The 55 modifier must be appended to the same surgical code used by the surgeon, they would need to apply the 54 modifier when they referred the patient to you to show they did the surgery, now you apply the 55 to show you performed the post op.

 

[dballard2004]

Just to add to Debra's comments here and to offer my opinion. Per CMS, in order to use modifiers 54 and 55 there has to be a written transfer of care agreement between the surgeon and your provider. If there is no such agreement, then your provider should be reporting the postoperative visits with an office/outpatient E/M code without modifier 55.

Now, this is CMS criteria. If this is a commercial payer, you will want to consult with them about any policies or criteria they may have for reporting modifiers 54 and 55.

Also, you don't indicate if these providers are in the same practice or not. If they are, you can't use modifiers 54 and 55 at all as the postoperative care would all be considered global because they are the same provider/same practice.

Hope this helps.

 

[maryawinfield04]

No, they're not within the same group. It's for a commercial insurance carrier. I billed 99024 with a -55 modifier because it's actually post-op care, i was applying the wrong modifier.

Thanks