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We have peds ortho. 2 locations, using 54 and 55 modifier

  1. #1
    Question We have peds ortho. 2 locations, using 54 and 55 modifier
    Medical Coding Books
    We are a large Orthopedic practice and have a pediatric ortho. that sees patients at our office twice a month and does surgery at another location in Pensacola (diff. TIN), then is doing the post op care here at a our clinic (in another city).
    His office in Pensacola is billing with the 54 modifier and we will bill the same procedure codes, same dos and under that location with a 55 modifier so we can get a percentage of post operative care, since he will see the patient in our office (diff. TIN), post operative.
    We have not had to bill this senerio yet.
    Does this sound correct?
    Any opinion is appreciated.
    Thanks so much
    Lynn, CPC

  2. #2
    Milwaukee WI
    Default What?
    No, it doesn't sound correct to me.

    I think it would make more sense for you to have a contact with the physician that for these types of cases he will pay you X for "renting" the office suite.

    Then his Pensacola office bills the surgery as is (pre and post care included), and he just pays you rent for the office for those patients.

    F Tessa Bartels, CPC CEMC

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