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Modifier stumper!?!?!?!?!

  1. Exclamation Modifier stumper!?!?!?!?!
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    I need desparate help. One of my "new to the practice" docs saw a patient in the hospital foe basically a follow up on someone else's surgeries. (Genius, I know) It was a one time only thing done in the hospital (no clue if it's ER or inpatient, we are guessing it is inpatient). Patient had an intramedullary rod placed in LT femur and a cervicothoracolumbosacral orthosis to control fracture of C7 and T1. How in the world would I code this one? Thanks all

  2. #2
    If your doc is same group/same specialty (as surgeon) it would be global post op and he could not charge.

    If he is not same group, I would think you would just charge follow up care code 99232? I don't think you would even need a modifier if you are not billing under same tax ID as surgeon.

    WHY did he see someone else's patient??

  3. Default
    Well the HUGE downfall is the patient had surgery with a different doc, at a different hospital ina different town with a different group. I have no clue why he saw this patient.

  4. #4
    So you were not kidding when you said "stumper"

    We get pt's who have had surg elsewhere also, I either

    A) get the original surgeon to write a transfer of care and I then mirror their surg charge with a mod 55, so then we get paid a % of surg and the pt is ours in global.

    B)if the original surg does not cooperate and give transfer of care as well as billing info. then I bill visits/consults as if it was a new pt who is not in a global.

    If the insurance co. denies my bill stating the pt is in global, I then call the insurance company and tattle on the orig surg, telling them "he" would not transfer care and split surg bill 54/55. They then either pay me or they recoup from the orig surg and I then bill with the med 55.

    I have had it happen both ways(they either pay me for post-op 55 or they just pay as normal on my bills)

    If your doc mistakenly saw this pt , I would just let it go.

    It's not pretty but I hope that helps?????

  5. Default
    HA HA That would work in a perfect world but of course mine is not. We didn't take over the care of the patient. It's kind of like he just saw the patient for the sake of see the patient. There was no reason for him to see the patient. The patient was sent back to the original doctor that did the surgery so 55 wouldn't even work. Welcome to my life.

  6. #6
    Who asked your doc to see the pt? You might be able to charge a consult or a daily rounding (if the insurance does not accept consult codes). You will not need a modifier and it should pay due to different tax id. Good luck!

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