AAPC - Back to school
Results 1 to 3 of 3

Thread: Modifier 54 Or Reduced Service?

  1. #1

    Exclamation Modifier 54 Or Reduced Service?

    AAPC: Back to School
    Our OBGYN providers have left our group effective 9/1/08. I am working on the billing for surgeries done in August, where the physician did a preop and surgery in august, while with our group, and the same physican will be doing the post op but billing under a different group practice, nothing to do with us anymore. Any suggestions to bill correctly for only the services he's done while with our group? I first wanted to use the modifier 54 on the surgery, but then realized he won't get credit for the preoperative work. If I bill and E/M for the preop with a 56 (preop care only) I think our carriers will hold a copay and since he did also do the surgery, I don't think that's fair. If I bill global, is that legal, since our group really isn't providing the post operative care, but the provider is. Would it be legal to bill a global, and maybe give a small percentage to the other group? It is a really unique situation where our group practice is a sub group of a hospital. The obgyn department was at our facility, and we bill seperately, they have now moved to a different group practice under the same hopstial but different billing group.

  2. #2


    Since this is a practice issue (and not simply dr) I would think 54 is appropriate.

  3. #3


    What ever you do, don't exchange money for services under the table. The insurance is the only one who should be giving payment to the provider. You're treading on Stark territory.
    adrianne, cpc

Similar Threads

  1. Can you bill for a reduced service
    By maryann1224@bellsouth.net in forum Cardiology
    Replies: 1
    Last Post: 10-09-2015, 11:37 AM
  2. Modifier 78 = reduced payment??
    By rossruth@live.com in forum Modifiers
    Replies: 1
    Last Post: 11-10-2011, 03:26 PM
  3. e&m reduced service
    By tnsburke in forum Modifiers
    Replies: 2
    Last Post: 09-02-2010, 08:43 AM
  4. Modifier 52 Reduced Services
    By Sott3935 in forum Medical Coding General Discussion
    Replies: 3
    Last Post: 04-09-2009, 12:43 PM
  5. Reduced service
    By mmagness in forum Modifiers
    Replies: 0
    Last Post: 02-18-2009, 08:09 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.