Post Op Management Only

thar1995

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I have a physician that has referred his Cataract surgeries out. My physician is only seeing the patient for post-op management. We are billing 66984 with modifier 55 but are getting denied payment. Medicare reason codes CO-125 - Submission/Billing Error and M53 - missing/incomplete/invalid days or units of service. We are billing for DOS we see the patient. We have then sent in corrected claims with notes on claim form of surgery date and which eye still denied. I am in the process of verifying that the surgeon is billing his claims with modifier 54.

I have about 25 of these claims that we are not receiving payment on. I need all the help I can get, please.
Thanks
Karen
 

BeckyL1958

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Post op management

I found this document, you probably already have all this information. If the surgeon didn't use the appropriate modifier on his claim I wonder if you can just bill an office visit since your physician performed no surgery and no global days would be applicable.
I hope this info helps you, good luck! :)

http://www.ncascade.com/PDF/CoMng-MediCareBilling.pdf
 
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