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Thread: Modifier 54 or 55 ?Help with coding

  1. #1

    Default Modifier 54 or 55 ?Help with coding

    AAPC: Back to School
    Wondering if someone would be able to help me out on this.
    My doctor covers for another doctor when that doc goes on vacation. They are not in the same practice. Can I bill for
    hospital visits if his pts had sx? A subsequent visit with a 55 modifier - would this be correct? TIA for any help
    Deb, CPC

  2. #2


    I would not use a 55 modifier. The surgeon would also have to use the modifier 54 with the procedure code he used to do the surgery. With Medicare, he gets paid 80% of the allowed with the other 20% being dividied by the days in the global period which is what you would receive for the days that you see the patient. Debby, CPC

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