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staple removal from doc other than performing

  1. #1
    Exclamation staple removal from doc other than performing
    Medical Coding Books
    We had a patient who had a surgery done for open reduction of a fracture by a physician at a different hospital. This patient came to our orthopod to have the staples removed since it was a closer drive. Does our doc bill the procedure with a modifier or does the E/M cover the staple removal? Please help asap.

    thanks!

  2. #2
    Location
    Columbia, MO
    Posts
    12,913
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    You must obtain a transfer of care from the physician that performed the surgery in order to bill for post op care. If the surgeon does not provide a transfer which must be written in the chart then you must bill the patient or write it off. If you do obtain the transfer of care then you bill using the code for the procedure performed with the 55 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default
    The first orthopods office is aware he was being seen by our doc. However, we are not sure if he will be follow up with us or the first orthopod. "Staples are removed. We discussed the K wire and I told patient to get confirmation from (first orthopod) before I would consider removing it." Still bill with the procedure code and modifier?

  4. #4
    Location
    Columbia, MO
    Posts
    12,913
    Default
    Yes but you must have the transfer of care and being aware is not the same thing. Once they know you are billing to obtain a part of what they have been paid they may not give you the transfer. If they have already received their reimbursement they will be asked for a refund. You will need to inform them that you are billing a part of their global with the 55 modifier. This arrangement is usually worked out in advance.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    oh ok, I understand! Thank you so much for your help and quick response!

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