Wiki Post op management only

[Cindy1955]

Can someone please tell me what CPT code to use in this case. Patient had mastectomy by another surgeon out of state, patient returned home and surgeon in town is manage postop care specifically just drain management I know modifier 55 but Medicare says you cant just use a E&M code with that modifier.

 

[mitchellde]

For Post op management only you do not use an E&M code. You use the surgical code for the procedure the patient had performed, and then you add the 55 modifier to that code. this takes the place of the E&M code.

 

[CodingKing]

Modifier goes with the code for the full procedure. The reason is the global rate is split into specific percentages based on pre-op, inter-op and post-op. The appropriate allowable cannot be applied otherwise. It may be more than or less than what the E&M would have paid should it not been a post op visit.

For example mastectomy simple, 19% of the global fee is allocated to the post op component which depending on what percent of Medicare you are reimbursed at that can be a big difference; for instance in Colorado thats $200 at 100% of medicare.