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Kathy Covington

  1. Default Kathy Covington
    Medical Coding Books
    Can two physicians in the same practice split their surgical billing if one provider does the surgery only on the patient and the other physician follows them in the post op period. They would use modifiers -54 and -55 respectively. (one surgeon is stopping surgery and will refer his patients to his partner for surgery, then do the post op follow up on them)

  2. #2
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    Tacoma, WA
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    Quote Originally Posted by kcovington View Post
    Can two physicians in the same practice split their surgical billing if one provider does the surgery only on the patient and the other physician follows them in the post op period. They would use modifiers -54 and -55 respectively. (one surgeon is stopping surgery and will refer his patients to his partner for surgery, then do the post op follow up on them)
    You should be able to split bill it with the appropriate modifiers.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default Kathy Covington
    Thanks for your answer. The MedGuide says that Physicians in a group practice should bill for the entire global package if the physicians reassign benefits to the group. The physician who performs the surgery is shown as the performing physician. So I guess it is legal for them to split the reimbursement up according to what each one does internally? I just don't want it to appear as a payment for the referral. If we make sure they document what they are each doing it isn't a problem?
    I just found that article on Med Guide. kc

  4. #4
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    Quote Originally Posted by kcovington View Post
    Thanks for your answer. The MedGuide says that Physicians in a group practice should bill for the entire global package if the physicians reassign benefits to the group. The physician who performs the surgery is shown as the performing physician. So I guess it is legal for them to split the reimbursement up according to what each one does internally? I just don't want it to appear as a payment for the referral. If we make sure they document what they are each doing it isn't a problem?
    I just found that article on Med Guide. kc
    It is certainly "legal" to bill the global under the surgeon and then have an internal process for reimbursing the physician who provides post op care, it may even be a bit easier. It can also be done by splitting the bill and using the modifiers, because each physician is providing specific parts of the surgery package. It may come down to how the insurance carriers view the situation. The information in MedGuide is just a guideline.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. Default
    Thank you so much for your info. kc

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