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modifiers 54, 55, 56

  1. #1
    Greeley, Colorado
    Question modifiers 54, 55, 56
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    I'm sure I am not alone on this question - if a patient has surgery elsewhere and another provider does post op care only, mod -55 is to be used on the surgical code. But how is the surgeon supposed to report the code? If only -54 is reported then they don't get credit for the pre-op management. Would you report the surgical code on separate line items, once with -54 and once with -56? Or is the code reported on one line with both modifiers?
    Lisa Bledsoe, CPC, CPMA

  2. #2
    Greeley, Colorado
    Default Anyone?
    Any takers on this?
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Default Good question
    I have never had a surgeon split this out before so I have never personally billed that side of this scenario. We have done the pre/post op work and billed for those but it has always been one or the other.

    My thinking is that the surgeon would report the code once with both modifiers. This may be a good time to make use of the 99 modifier that indicates multiple modifiers.

    Good luck,

    Laura, CPC, CPMA, CEMC

  4. #4
    Milwaukee WI
    Default 54 modifier only
    If you try to use both 54 and 56 you'll get a denial for un-bundling.

    The surgeon reports with the 54 modifier only. The breakdown is pretty small for the pre- and post op care. The really large majority of the fee goes towards the actual procedure.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Greeley, Colorado
    Thumbs up
    Thanks Laura and Tessa. We have encountered this several times recently. Our docs are doing post op but the surgeon has billed global. I want to call the surgeons offices and let them know they need to not bill the global. I will call them and tell them they need to use -54 only on their claims.
    Lisa Bledsoe, CPC, CPMA

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