Wiki Modifier -55

[cowderyl]

I have used this modifier in the past and received payment for an E/M code. The surgery provider has left town and another neurosurgeon is doing following for the 90 day global. He has never seen these patients before. Doew anybody know for commercial insurance if this is appropriate adding the -55?

 

[sbicknell]

If both neurosurgeons are same specialty and same practice/group, then the global period applies to both. Even thou another NS did the global f/up, all NS in that group are considered as one.

This prevents the passing around of the patient to other surgeons in the group to circumvent the global billing rules.

In order to code the 2nd NS with mod -55 your must bill (or rebill) the 1st NS claims with mod -54. There has to be a 54/55 match or your claims will deny

The 2nd NS codes the surgery CPT with mod -55 and then assumes the global period for that CPT. And he should assume all 90 days of post-op care. In other words he can not bill with -55 and then pass the patient back or to a 3rd NS after 30 days. Flip-flopping is frowned on by CMS

54 Surgical Care Only: When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.

55 Postoperative Management Only: When one physician performed the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number.

56 Preoperative Management Only: When one physician performed the preoperative care and evaluation and another physician performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number