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Thread: modifier 55

  1. #1
    Join Date
    Apr 2007

    Default modifier 55

    AAPC: Back to School
    Here is the senario.
    Dr A did an apendectomy on this patient at hospital A and coded his surgery with modifier 54 ( surgical care only) then the patient was transfered to Hospital B because of a high risk issue and my provider Dr. B assumed the post-op care only (mod 55). Dr B provided services and admitted the patient to hospital B. My question is can my provider (Dr B) bill for the admission of this patient and the post op-care? Or is the admission part of the post-op care (mod 55).
    Thank you

  2. #2
    Join Date
    Apr 2007
    San Juan

    Default Modifier -55

    Is this Medicare? if so, modifier -56 does not apply. However, you can bill using modifier -55 along with inpatient follow-ups visits.

    Medicare Claims Processing Manual:
    "• If the transfer of care occurs immediately after surgery, the physician other than the surgeon who provides the in-hospital postoperative care bills using subsequent hospital care codes for the inpatient hospital care and the surgical code with the “-55” modifier for the post-discharge care. The surgeon bills the surgery code with the “-54” modifier."

    Gabriel Rafael Aponte, MBA, RN, CPC, COC, CIC, CRC, CPMA, CCC, CHONC, CCS, CCS-P, CDIP

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