Wiki Provider switches practices-how to bill in a post op period

micki127

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Hi,

Can any one please tell me the correct way to bill this out? If a provider does a surgery at another facility and then comes on board to our practice do I bill the office visit as a post op or would I bill out the E/M level with a modifier (assuming that the diagnosis is directly related to the surgery)?

Thank you in advance for your advice,
Micki
 
The correct way to split the surgical and post-operative care between providers (or in your case practices) is to bill the surgery with modifiers 54, 55 and 56 according to which entity performed which components. So in your case, the original facility that employed the physician would have had to bill the surgery with modifier 54 and your practice would bill the same code with modifier 55, but this requires coordination between different providers and may or may not be worth the effort. The guidelines are in the Medicare Claims Processing Manual Chapter 12, sections 40.1 and 40.2. It wouldn't be appropriate to bill routine postoperative care with E/M codes since it is not eligible for reimbursement separately from the global payment.
 
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