If there was an official transfer of care, then the answer by
@Partha is correct. What you are describing does not necessarily sound like a transfer of care, but rather the surgeon did the surgery and is now referring to you for treatment of a problem and not for postop care. If so, then code as 9920___ no modifier required.
IF there was a transfer of postop care, this is all in the
Medicare global surgery booklet, which is currently off the CMS website being reviewed. Here is relevant information from that document, which is possible to be changed once the document has finished review.
Physicians Who Furnish Part of a Global Surgical Package
More than one physician may furnish services included in the global surgical package. It is possible that the physician who performs the surgical procedure does not furnish the follow-up care. Payment for the postoperative, post-discharge care is split among two or more physicians where the physicians agree on the transfer of care.
When more than one physician furnishes services that are included in the global surgical package, the sum of the amount approved for all physicians may not exceed what would have been paid if a single physician provided all services, except where stated policies allow for higher payment. For instance, when the surgeon furnishes only the surgery and a physician other than the surgeon furnishes pre-operative and post-operative inpatient care, the resulting combined payment may not exceed the global allowed amount.
The surgeon and the physician furnishing the post-operative care must keep a copy of the written transfer agreement in the beneficiary’s medical record. Where a transfer of care does not occur, the services of another physician may either be paid separately or denied for medical necessity reasons, depending on the circumstances of the case. Split global-care billing does not apply to procedure codes with a 0-day postoperative period.
Using Modifiers “-54” and “-55”
Where physicians agree on the transfer of care during the global period, services will be distinguished by the use of the appropriate modifier:
• Surgical care only (modifier “-54”)
• Post-operative management only (modifier “-55”)
The physician must use the same CPT code for global surgery services billed with modifiers “-54” or “-55.” The same date of service and surgical procedure code should be reported on the bill for the surgical care only and post-operative care only. The date of service is the date the surgical procedure was furnished.
Modifier “-54” indicates that the surgeon is relinquishing all or part of the post-operative care to a physician.
• Modifier “-54” does not apply to assistant-at-surgery services.
• Modifier “-54” does not apply to an Ambulatory Surgical Center (ASC’s) facility fees.
The physician, other than the surgeon, who furnishes post-operative management services, bills with modifier “-55.”
• Use modifier “-55” with the CPT procedure code for global periods of 10- or 90-days.
• Report the date of surgery as the date of service and indicate the date that care was relinquished or assumed. Physicians must keep copies of the written transfer agreement in the beneficiary’s medical record.
• The receiving physician must provide at least one service before billing for any part of the postoperative care.
• This modifier is not appropriate for assistant-at-surgery services or for ASC facility fees.
For more information, refer to the Medicare Claims Processing Manual, Chapter 12, Sections 40.2 and 40.4.
Exceptions to the Use of Modifiers “-54” and “-55”
Where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate E/M code. No modifiers are necessary on the claim.
Physicians who provide follow-up services for minor procedures performed in emergency departments bill the appropriate level of E/M code, without a modifier.
If the services of a physician, other than the surgeon, are required during a post-operative period for an underlying condition or medical complication, the other physician reports the appropriate E/M code. No modifiers are necessary on the claim. An example is a cardiologist who manages underlying cardiovascular conditions of a patient. For more information, refer to the Medicare Claims Processing Manual, Chapter 12, Sections 40.2 and 40.4
