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54 modifier

  1. #1
    Question 54 modifier
    Medical Coding Books
    Hey all,
    I am hoping that someone may be able to help me with this. I do not do a lot of surgical billing, but we have recently acquired a surgeon. He does bill a lot of his surgeries with a 54 modifier, but then he has seen the pt back in about a week (to remove the staples etc) and he wants to bill for these visits. Can we do that since he has billed the surgery with a 54? Wouldn't they be included in the charge for the surgery?

    Missy Heuer CPC, CIRCC, CANPC

  2. #2
    Milwaukee WI
    Default Why use 54?
    Why is he using a -54 modifier if he is going to see the patient post-operatively?

    He cannot simply use it to unbundle the pre- and/or post-op care.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default
    I agree with Tessa. He cannot bill for things that are routine post operative care. I work for a large group of general surgeons. We have never used a -54 modifier. And do not charge for follow up care unless there is a complication that leads to surgery.

  4. #4
    Thanks! - That is what I thought but I just wanted it confirmed.
    Missy Heuer CPC, CIRCC, CANPC

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