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unique post-operative follow up visit situation

  1. #1
    Default unique post-operative follow up visit situation
    Medical Coding Books
    Our local hospital is going to hire several part time surgeons to perform surgeries through their ED. And they will no be around for the post op follow up so they want to send them to our General Surgeon for post op care. We are trying to figure out how to get our surgeon paid. The facility is not going to be billing the surgeons portion of the billing. They are only going to be billing the facility billing. Their will be not Global surgery billing done. So we will not be able to attach the 55 modifier to the CPT code to Medicare as they will not pay without the 54 part being billed as will. My question then is will we be able to bill an office visit with the V67 codes and not be denied as routine by insurances like Medicare or other carriers when we had nothing to do with the original service? Secondly, would our part of the post operative serice be covered by the original authorization number? Any thoughts or ideas out there by anyone who might have dealt with anything close to this kind of thing before?

    Thanks for your help.

  2. #2
    If the surgeons at the hospital have no intention of doing follow up postoperatively, they are coding non compliantly when they do not code the 54 modifier.

    Your surgeons have to have a meeting with the hospital compliance department, and the surgeons in the hospital to discuss this. They need to bill the surgeries with the 54 modifier and be paid only the interoperative allowance and your surgeons bill the surgery with the 55 modifier for the post operative management.

  3. #3
    Daytona Beach, FL
    Default another surgeon doing hospital follow up
    Somewhat in the same situation - our Ortho will do follow ups in the hospital on patients that had surgery but the original surgeon is not available to follow up. My Ortho is not taking over the complete post op management, just the days when the operating doc is not available. The other surgeon does the same for our Ortho and bills for these servcies. My doc just started to turn these visits in to me since she found out the other doc is billing (she thought she couldn't charge for these visits). How do we bill for the E/M provided and get paid?

    Thanks for any help!
    Jodi Dibble, CPC

  4. Default
    you don't get paid for that. Any surgeon who sees a patient during the post op period of another surgeon either does it for free, or has to assume the entire post op course for that patient. This is why most surgeons HAVE receiprocal arrangements such as this. "I won't bill for your post op visits, and you don't bill for mine". Your ortho may not be getting paid for that other doctor's post op patient visits, but from the insurance companies perspective, she IS getting paid when that other doctor sees HER patients.

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