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Thread: Please Help with Modifier 54 or 55

  1. #1

    Default Please Help with Modifier 54 or 55

    AAPC: Back to School
    My doc covered for another surgeon and just wondering if
    it is appropriate to bill for the hospital visits during postop
    period. Ex: Choleycstectomy by Dr. X (Dr.X goes on Vacation) Dr.Y is covering NOT from the same practice.
    Sooo can Dr.Y bill a hospital visit 99231 54/55Which modifier___? Thanks in advance for any help
    Deb, CPC

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Depends on arrangement

    This may depend on the arrangement you have.

    If Doctor Y is serving in locum tenens for Doctor X then No ... because he is acting as if he were doctor X.

    If the doctor X went on vacation and told his patients "if you have a problem you can see doctor Y in my absence" then you might be able to bill these.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3

    Default Thanks for reply Modifier 54-55

    The pts are still hospitalized following surgery so thats
    why I was wondering. Also, would it have been
    modifier 54 or 55. (Guess considering the attending
    did go on vaca. and even though my doc is covering
    they would still technically be in the postop global Correct?
    Thanks again
    Deb, CPC

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