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Modifier 54

  1. #1
    Loma Linda
    Cool Modifier 54
    Medical Coding Books
    Could someone please help to understand this modifier and when should it be used.
    Sarah M., CPC

  2. Default Modifiers
    If you look in the CPT book it gives all the explanations of Modifiers and what type of visit to use it for in he medicare compliance books your office should have shows you if the code can be billed with a modifier.

    if you have a 99213 & a 31575 a modifier 25 should be added typically you would add 25 on to the office call with any other service performed during that time.

  3. #3
    Loma Linda
    Cool modifier 54
    the doctor i bill for provides woundcare for patients that have had surgical procedures he said that he heard that he is suppose to attach the mod 54 when he does woundcare. for example. woundcare is being done, surgical debridement is requested and once it is done he resumes the woundcare. surgeron debrides a wound then consults with him to assume care for this patient which is new to him to continued woundcare. a surgeon perorms surgery a complication occurs and the surgeon consults with him for care.
    surgical wound dehisces and physician other than the surgeon (like PCP) requests a wound consultant to take over management.
    Sarah M., CPC

  4. #4
    Columbia, MO
    The 54 modifier is attached to procedure codes and not E&M codes, it is used to show that the physician who performed the surgery has transfered all or part of the post operative management to another physician. The Medicare manual states that a transfer of care is required and that documentation in the medical record must show that your physician was requested to step in, also a transfer of care note is to be inputed into box 19 or the "notes" section. You use the same procedure code as the procedure performed and append a 54 modifier to it. typically the reimbursement is 20% of the surgical allowable, then divide that by the postoperative global days and then multiply by the number of days your physician will see the patient until the global expires so for example a 90 global for a $1000 allowable would give you $200 for the post op, then devide by 90 = $2.22 per day so if on day 15 of the global the care was transferred to your physician the reimbursement would theoretically be $166.67 total for the remaining 75 days. I hope this helps.

  5. #5
    Loma Linda
    Thank you very much.. It does help.
    Sarah M., CPC

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