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Modifier 54 Or Reduced Service?

  1. Exclamation Modifier 54 Or Reduced Service?
    Medical Coding Books
    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. Default
    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

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