The surgeon who performed the procedure is not asking the anesthesiologist to resume the total post op care. Just provide post op pain management initially following the surgery before the patient is discharged. If the Anesthesiologist met the documentation criteria of HPI detailed. Exam Detailed (extended 2-7 organ systems) (2 bullets from 6 areas/systems or 12 bullets from 2or more area/systems) MDM Low, then 99221 could be reported. This would differ from the attending claim (AI modifier for the attending). Here is another explanation if the documentation does not meet--Det, Det, Low
When the initial hospital care that you used to bill to Medicare using a consultation code does not add up to the lowest-level inpatient care code, what do you do? This has been the million dollar question since the first day of this year when Medicare stopped accepting consultation codes. <br />
CMS offers a solution for when your neurosurgeon's initial hospital care does not meet the requirements of 99221. <br />
Payers should overlook initial/subsequent mismatch <br />
According to CMS, even when the provider documents an initial visit, Medicare contractors should not find fault with providers who report a subsequent hospital care CPT code in cases where the medical record appropriately shows that the work and medical record rightly demonstrate that the work and medical necessity requirements are met for reporting a subsequent hospital care code. <br />
Modifier Description 54
Surgical care only: when 1 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.
Modifier Description 55
Postoperative management only: when 1 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.
ModifierDescription 56
Preoperative management only: when 1 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.