Wiki Modifiers in post op/global periods.

[Peterk50]

Hi


This week I really feel like I need to attend modifier school. Please clarify for me in layman terms. When any type of procedure that has a global period, and another provider other than the one doing procedure (but of same field) you can charge a subsequent E/M as long as you add a modifier 55? Or is it only when the provider is of another group of same field that an e/m with modifier 55 can be billed?

Thank you

 

[mitchellde]

Hi


This week I really feel like I need to attend modifier school. Please clarify for me in layman terms. When any type of procedure that has a global period, and another provider other than the one doing procedure (but of same field) you can charge a subsequent E/M as long as you add a modifier 55? Or is it only when the provider is of another group of same field that an e/m with modifier 55 can be billed?

Thank you

I am not certain I understand your question. However 55 modified cannot be used on E&M codes, it may be used on surgical codes only. The 55 modifier is for use when the surgeon transfers postoperative care of a patient to a different provider. This usually occurs when the patient opts for post op care closer to home, or sometimes when they have issues with th surgeon and reques a different provider for follow up. You would use the surgical code for the procedure performed and append the 55 modifier. You also use box 19 to indicate a transfer of care.

 

[thomas7331]

I think this publication by CMS is a really good reference tool for how the global surgery concept works, and it covers almost everything you need to know about how the modifiers are used:

https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf

 

[Peterk50]

modifier

Thank you !

 

[divyan]

Thank you. modifier link very useful.