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55 Modifier???????

  1. Question 55 Modifier???????
    Exam Training Packages
    Can anyone please tell me exactly how to use the 55 modifier? I have a patient that we took over her care after a hemiarthroplasty. I know we billed it before but I cannot remember for the life of me how we did it and I can't remember who that patient was to look back at it. Thanks for all your help.

  2. #2
    Columbia, MO
    The 55 modifier attaches to the surgical of the surgery you took over management for, do not code an E&M.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    I remember that we billed the fracture with the 55 modifier and it denied. This is the result of our confusion. This time we are billing a 99244 with the 55 and no fracture. This is so fusterating. Thanks in advance.

  4. #4
    Columbia, MO
    OK , first this is a fracture care follow-up? Then you need to know how the original ortho billed, if he billed fracture care then you must use the same code they used with the 55, if the billed alternative fracture then they used an office visit with a splint or cast code which means there is no global so the aftercare is an office visit with no modifier. The dx code will be a V54.x code not the acute fracture code and now you will be good to go. The 55 can not be appended to an office visit it is for surgical codes only.

    Debra A. Mitchell, MSPH, CPC-H

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