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Modifiers 54, 55, 56 and Transfer of Care

  1. #1
    Overland Park, KS
    Default Modifiers 54, 55, 56 and Transfer of Care
    Medical Coding Books
    Per CMS, in order to report modifiers 54, 55, or 56, there must be a written transfer of care agreement between the providers (or surgeon). The CMS guidelines state the agreement may be in the form of a letter, or a notation in the d/c summary or chart indicating care is being transferred from one provider to another.

    Here is my question...If a patient (not of the clinic) comes into the clinic for a laceration repair or fracture care only and all we do is repair the laceration or treat the fracture and then we notate in the chart, "Pt to follow-up with PCP upon returning home within a week," is the above notation sufficient for a transfer of care so we can bill the procedure with modifier 54?

    PS-I know the simple laceration repair codes no longer have a global period per CMS effective January 1, so let's say we did an intermediate repair.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  2. #2
    Columbia, MO
    Yes is the answer to your question. Also provide the patient with instructions to FU with PCP so they can give the order to the PCP, they must have it in the patient chart as well.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Overland Park, KS
    Thanks Debra! I greatly appreciate your insight!

    One more question on the above scenario would you also report modifier 56 for the preoperative work, or would this be more captured by the E/M with modifier 25?
    Last edited by dballard2004; 02-01-2011 at 06:53 AM.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

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