This sounds like a Global fee/split care:
Per Medicare A surgeion who does not provide follow-up care would use modifier -54 (surgical care only). The doctor who provides pos-operative follow-up care should use modifier -55 (post-operative management only).
You can get credit for giving post-op care starting from the date of transfer even if you haven't seen the patient yet. But you can't file a claim for your reimbursement until after you've provided a service [CMS 100-4, 12 40.2 (A)
Note: Before you bill for split care, keep the following exceptions in mind:
- If there is not an official transfer of care, the second doctor may bill occasional post-discharge services with the appropriate E/M code. You don't need a modifier for such claims.
- If the transfer of care occurs immediately after surgery, the second physician bills using subsequent hospital care codes for the inpatient hospital care and the surgical code with modifier -55 for the post discharge care. The surgeion bills the surgery code with modifier -54.
- If the serives of a physician other than the surgeon are required during a post-operative period for an underlying condition or medical complication, the second doctor should report the appropriate E/M code. You don't need a modifier. Example: A cardiologist who manages underlyin cardiovascular conditions of a patient.
Hope it helps.
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