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setting shoulder in ED and f/u with ortho

  1. #1
    Rockford, IL
    Exclamation setting shoulder in ED and f/u with ortho
    Medical Coding Books
    A patient comes into the ED for bilateral setting of shoulders. Should the ED bill the setting of the shoulder with -54 modifier and the Ortho doc charge with -55 modifier? The orthopedic physician wants to charge Office visits for follow up care. He does not feel he should be part of the global package. Both physicians are employed by the organization, but the orthopedic physician states he has a specialty (different class then ED physician), but there is a global package. One conference I attended stated "if you split the global package, there needs to be a written note to the post op physician taking over the care, so the physician can bill correctly with modifiers.
    Please give me your expertise
    Sheila Sweetland, CPC

  2. #2
    Milwaukee WI
    Default Post op split
    Yes, if one physician performs JUST the "surgery" and another physician of a different group (or different specialty within the same group) performs the postoperative care you should be using -54 and -55 modifiers. The different specialties do not really matter.

    Not sure what code you are talking about, but let's take 23650 as an example.

    ED would bill 23650-54; ortho would bill 23650-55 (and get about 21% of the total fee usually paid for 23650).

    If they have a shared record (as would be the case for OUR practice), the fact that ED note states "patient to be followed by Dr Ortho," and then Dr Ortho's first visit noting the patient's treatment by ED would be enough to satisfy the requirement for a formal transfer of postoperative care.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 11-05-2009 at 09:32 AM.

  3. #3
    Rockford, IL
    Thank you very much. I appreciate your quick response

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