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HELP!! Billing E&M's after the 55 modifier

  1. #1
    Default HELP!! Billing E&M's after the 55 modifier
    Medical Coding Books
    Hi...if we are the group billing the 55 modifier, post op care only, can we still bill for subsequent care codes during that same inpt stay, as long as the care has been immediately transferrred to us? If the pacer was inserted on 10/1/14 33208-55, can we bill for the subsequent care codes for 10/2, 10/3 and the discharge on 10/4? Please advise!! We are in a state of confusion all of a sudden. thanks Sandy

  2. #2
    Location
    Columbia, MO
    Posts
    12,910
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    If you bill the procedure code with the 55 modifier then you do not bill for post op visits with E&M codes.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Ok, I was told that meant after the hospital, follow up in the office only. so, then billing with the 55, is payment for all the aftercare???

  4. #4
    Location
    Columbia, MO
    Posts
    12,910
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    Yes that is correct.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    Hi...so the reimbursement we get from billing the procedure with the 55 modifier, is in place of billing for the aftercare visits. I just want to understand this!! thank you Sandy

  6. #6
    Location
    Baton Rouge
    Posts
    1,241
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    Quote Originally Posted by sandya View Post
    Hi...so the reimbursement we get from billing the procedure with the 55 modifier, is in place of billing for the aftercare visits. I just want to understand this!! thank you Sandy
    Yes, this is correct. The RVU file shows the breakdown, by percentage, of each surgery code for pre-op, intra-op, and post-op, care.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  7. #7
    Location
    Columbia, MO
    Posts
    12,910
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    Yes in most cases the 55 modifier is 10% of the surgical allowable. So if the global surgical allowable is 1000 then you get $100 for all the post operative visits. For some payers and some procedures this may be as much as 15% and rarely 20%.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Default
    Wonderful!! thank you that makes total sense!!!

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