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New pt E/M

  1. Question New pt E/M
    Medical Coding Books
    A patient was injured in another state & received surgery with a 90 day global. The pt. comes back home & comes in to see your Dr. as a new patient. Can you bill a new pt E/M & the surgery with code with modifier {55} or do you just bill the surgery code with modifier {55}?

    Thanks for all your help.

  2. Default
    I ended up billing the surgery with modifer [55].

  3. Default
    Let me understand your senerio. Pt was injured and had surgery in another state. Came back to his home town, after surgery, to do follow up visits or post op visit.

    And you want to know if you can charge an E/M and the surgery or did patient have to have another surgery with your doctor?

    You can charge E/M code with mod 55 but you can not bill the orginal surgery. Now if he had to have additional surgery, you would use mod 58 or 78 depending on the issues with the first surgery.

    Hope this helps.

  4. #4
    You should not be putting a mod 55 on an E/M code.

    It is my understanding that an agreement has to be made between the two docs that there has been a transfer of care, so the surgeon can bill with the 54 and the post-op follow up can be billed with the mod 55 attached to the surgical procedure that was done, you also have to use the date of the surgery as your date of service. I usually put a comment in box 19 stating the date we took over care of the pt, which is ususally the pt. first visit to our doc.or the date on the transfer of care.(I believe medicare requires a written transfer of care)

    I have encountered some instances where the surgeon refuses a transfer of care, and refuses to bill with the 54. In this case I have done 1 of 2 things, either I call the payor and ask them how they want me to bill it or I bill as new pt. like any other new pt.

    I have been paid both ways. You should call your payor and ask them.

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