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Confused on Modifier 54

  1. #1
    Overland Park, KS
    Default Confused on Modifier 54
    Medical Coding Books
    I'm a little confused on the correct usage of modifier 54. Is this modifier limited to only procedures with a 90 day global period, or can it be used for procedures with a 10 day global period?

    For example, if we had a patient (not our patient) come into the office with a fracure to his/her hand and we repaired it, and applied a cast,but we told the patient to follow-up with his/her PCP, can we append modifier 54 to the fracture code?

    This is a non-Medicare, so we do not have to have a request for transfer of care, correct?

    Last edited by dballard2004; 04-28-2010 at 10:00 AM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  2. #2
    Columbia, MO
    54 can be used for any procedure that has a global post operative time frame. It will indicate that your physician performed the surgical service only.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Overland Park, KS
    Thanks so much!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  4. #4
    Milwaukee WI
    Default Let the PCP know
    Be sure to let the CPC know that s/he should also bill the same fracture care code with -56 modifier.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Overland Park, KS
    I see because the preop was also done! Perfect! If the fracture was done on the right hand, would we also use RT modifier along with 54 and 56? Thanks as always!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

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