Modifiers for two proviers

[ajballard]

We are having a debate in our office and need some assistance. We code in a Rurual Health Hosptial so we have a different opinion on how to answer this question. (We found this question and answer from another site).

The patient is from Nebraska and is visiting Yellow Stone national Park. He falls while hiking and the injury requires an open surgical fracture of his left humerus (CPT code 23615). Surgery is performed by Dr. A. The patient is released two days later from the hospital and then seen by his home town doctor (Doctor B) in Nebraska for the post-op care. How are the services billed by each Doctor A and Doctor B?

A. Doctor A 23615 for entire surgical package
B. Doctor A 23615-54 Doctor B 23615-55
C. Doctor A 23615-62 Doctor B 23615-62
D. Doctor A 23615-54 Doctor B 23615-24

Since we are coding in a hospital, would the coding be the same if it were in a clinic?
Please explain your answer so we can a thorough understanding of what your thinking

Thank you so much!!!

 

[bdcoyne8]

It would be option B.

It can't be A as the surgeon is no longer treating the patient and therefore there are no follow up visits.
C is for the time in the operating room. Both providers would get the 62 if they BOTH participated in the actual surgery and worked side by side each other.
D, the modifier 24 is for services UNRELATED to the procedure that has the global surgery.

Modifiers 54 and 55 were created to break up the global package. That way the payors pays the surgeon a reduced amount (the amount that would have gone towards any follow up time spent) and the other provider can bill for those visits and get paid.

Without those modifiers, the surgeon gets all the money while the follow up provider gets denied or gets paid at a reduced amount.

Hope this helps!