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Do you use a modifier 55 when a PCP sees pt after surgery?

  1. #1
    Default Do you use a modifier 55 when a PCP sees pt after surgery?
    Medical Coding Books
    Good evening!

    I was wondering if I would need to add a modifier 55 to 99214 when a patient followed up with her PCP after a cholecystectomy. The PCP did not have a transfer of care. He just encourages his patients to see him any time they have a hospital visit so he can review things with them.

    When I looked this up on CMS.gov, they state:
    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.

    So would I or would I not add a modifier? The patient is following up with the surgical office, too.

    Thank you so much for your help! It is so appreciated!

    Noelle

  2. #2
    Location
    Columbia, MO
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    You cannot attach the 55 to an office level it goes with procedure codes only and you are required to have a transfer of care to bill surgery related post op visits. Therefore if this is related to the surgery you can either write it off or bill the patient or have them follow up with the surgeon.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    Thank you so very much, Debra, for your response! That makes so much sense and I really appreciate your input! Thank you and this forum for being such a great resource! It helps a ton!

  4. #4
    Default Follow Up...Would a modifier 24 be applied?
    Good evening!

    If anyone could please clarify this for me, it would be appreciated. I thought of another question on this topic. If you wouldn't use a modifier 55 when a PCP sees a patient after gallbladder surgery, would you use a modifier 24 or no modifier at all? I wasn't sure with it being during the postoperative global period if a modifier had to be added if they are seeing their primary care physician and not the one who did the procedure?

    Thank you again!
    Noelle

  5. #5
    Location
    Columbia, MO
    Posts
    12,924
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    If the PCP is seeing a patient in a post op time frame for issues unrelated to the surgery, then the PCP needs no modifier. The 24 modifier is for the surgeon to use when seeing a patient in the post op period for issues unrelated to the surgery.

    Debra A. Mitchell, MSPH, CPC-H

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