pain management


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I had one of our physicians question a scenario and was wondering if anyone could advise. If a patient had a post op pain catheter placed intraoperatively and we billed for it seperately with a 59 modifier, would there be any other billing opportunities if for example 3 hours post op another physician from the pain team went to see this patient in the pacu, checked their catheter,explained the management of the catheter to the parents and then the patient was discharged to home with the physician following up by phone postop day 1 to see how the patient was doing?:)


Cherry Hill, NJ
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from your post, it sounds like a physician other than the one who performed the procedure evaluated the patient in the PACU, talked to the family about the cath, and followed up with the patient the day after (typical post op follow up?). these are all things that are normally included in the global package when performed by the same physician who did the surgery. but if it's a different doctor, if this is all correct, then the physician that did the post op may be able to bill post op only (modifier -55). you would have to make sure of a couple things though:

1. the second physician has to be doing all the post op care
2. the physician that performed the procedure would have to bill preop and surgical care only, so the reimbursements would be correct

also remember with modifiers -54, -55, and -56, it's supposed to be with the surgical code, not an E/M, as the modifier represents a percentage of the global fee (for medicare it's 70%, 20%, and 10% respectively). but, as you explained it, it sounds to me like the second physician could be able to bill postop management. hope this helps! :)