AAPC - Back to school
Results 1 to 2 of 2

Thread: post operative visits/when surgeon did not perform the surgery

  1. #1
    Join Date
    Apr 2007
    Dickson, TN

    Default post operative visits/when surgeon did not perform the surgery

    AAPC: Back to School
    I need some help with an issue that is coming up in our practice. The hospital where our general surgeons perform services has employed two surgeons who will perform surgery and then transfer care for the post operative period to your general surgeons. How should we be billing this post operative services? The hospital is not billing the surgery service provided by their surgeon, so if we use the procedure code with a 55 modifier it is likely not going to get paid as the procedure code will never be submitted with a 54 modifier. Are we allowed to bill a Regular E/M code or should we have a contract with the hospital to cover these cases?

    any help is greatly appreciated.
    Debbie Potts England
    Lyles, TN 37098

  2. #2
    Join Date
    Apr 2007


    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.
    Kiana CPC, CPC-H, BCS-M, BCS-R

Similar Threads

  1. Post operative visits
    By cknighton@fchn.org in forum Orthopaedics
    Replies: 0
    Last Post: 10-21-2014, 06:00 AM
  2. still global if we didn't perform the surgery?
    By avrilw in forum Family Practice
    Replies: 2
    Last Post: 02-13-2014, 05:54 PM
  3. Hospital visits post surgery
    By OhioMB in forum Cardiovascular Thoracic
    Replies: 3
    Last Post: 04-16-2013, 10:08 AM
  4. Replies: 1
    Last Post: 10-03-2011, 08:42 AM
  5. Number of Post-Op Visits included in Global Surgery
    By KKCODER in forum Medicare Regulations
    Replies: 3
    Last Post: 08-20-2009, 04:27 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.