To use a 55 mod, you need to obtain the surgical code and submit that with the 55 on it. This signifies that your physician did all the post op care usually provided by the operating surgeon.
It decreases the pay of the operating surgeon also. (If I remember correctly it is about 17%) So you need to notifiy the operating surgeon. I also believe it has to be documented in writing from the original surgeon requesting transfer of care.
This is NOT a recent article, but I couldn't find anything more recent that was different.
Modifier -55 is used when one physician does the surgery and another physician provides post-operative care. To bill for post-operative care without performance of the surgery, attach a modifier -55 to the procedure code. Post-operative care begins the day after the surgery. If it becomes necessary for the surgeon to address a problem during the post-operative period, it can be billed separately if the service contains a diagnosis which is separate from the original procedure.
Management of patient-controlled medications are included in the surgeonâ€™s payment for the surgery. Pain management by a continuous epidural is considered billable and would be billed using CPT code 62319 on the first day. This includes the catheter and injection of the medication. Subsequent daily management of the epidural can be billed using CPT code 01996. Both codes cannot be billed on the same day.
Any visit performed by the surgeon, which occurs one day prior to the surgery, is considered to be included. For example, when a patient undergoes a cardiac procedure performed by a cardiothoracic surgeon and then the follow-up care is rendered by the patientâ€™s cardiologist, Modifier -55 would be added to the codes submitted by the patientâ€™s cardiologist. Modifier -55 can have an effect on payment of the service and may be used on Medicare claims.
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