Wiki Modifier 56 and Referrals

[CGephart]

If a patient comes to your office for a pre-op exam and your not part of the surgeon's group, can you use modifier 56? If yes, do you need a referral?

 

[Jewel Mccray]

yes the modifier 56 can be used and you don't need a referral

 

[FTessaBartels]

No referral needed, but you DO need the CPT

You don't need a referral, but you will need to know what primary CPT the surgeon will be using for the surgery. You code THAT CPT with the -56 modifier. The surgeon will use a -54 modifier. The payer will split the "global fee" accordingly between the two physicians.

Hope that helps.

F Tessa Bartels, CPC, CEMC