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Thread: Modifier 54

  1. #1
    Join Date
    Apr 2007
    Capital Coders, Columbia, SC

    Question Modifier 54

    AAPC: Back to School
    Does anyone have experience with modifiers 54 and 55? I am looking for specific guidelines on when the use of modifier 54 is allowed. I understand it unbundles the surgical package to represent surgical care only. Aside from the scenarios such as: Surgeon A sending his patient to Surgeon B because Surgeon A does not perform a particular procedure, or a patient is injured far from home, has a procedure and returns home for follow up care, or an ED surgeon appending modifier 54 because he only works in the ED and does not furnish follow up care, can modifier 54 be used in an urgent care setting, by a physician who performs a fracture treatment (with manipulation), but then refers the patient to an orthopedist for follow up care?


    Bill Hale, CPC

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default -54 modifier

    Bill ... your example where your urgent care physician performs fracture care ONLY but sends the patient to an orthopaedic surgeon for the follow-up is a perfect scenario for using the -54 modifier on the fracture care code.

    If you know the orthopaedic surgeon (perhaps in the same practice?) then I'd coordinate with that surgeon's coder to ensure they use the same fracture care code with the -55 modifier. That will "complete the loop."

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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