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Billing Services in post-op care

  1. Question Billing Services in post-op care
    Medical Coding Books
    Our general surgeons are providing inpatient post op care to patients of another general surgery practice in town. Can we bill any kind of hospital visits since we did not perform the surgery? If we can how should we bill these services?

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    Why are the general surgeons who performed the surgery, not performing post-operative care?

  3. #3
    Default
    If you do bill for post op care only, you would need to add modifier 55 to the cpt code.

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    Quote Originally Posted by kforkismet View Post
    Why are the general surgeons who performed the surgery, not performing post-operative care?

    They are rotating call at the hospital, so the surgeon who performed the surgery was off, and our surgeons took care of the other groups patients.

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    Quote Originally Posted by hopegwd View Post
    They are rotating call at the hospital, so the surgeon who performed the surgery was off, and our surgeons took care of the other groups patients.

    Ok, that makes more sense. Modifier 55 would be appropriate if your provider happens to be on call and must see the patient.

    The only thought-provoking thing that comes to mind is that this should not be a consistent situation where your providers are always providing postoperative care for the other surgeon's patients, and the other surgeons are not always providing care for your surgeons patients.

    If that were appropriate, and not illegal, wouldn't that be a great way to get around a surgeon not being able to be reimbursed for postoperative care?

    Hope this helps.

    Kris

  6. #6
    Default
    If you are going to bill the postop care with the 55 modifier, you better make sure that the surgeon who did the surgery isn't billing for it already by billing the surgery code without a modifier. He would need to bill his services with the 54 modifier or else he's already gotten paid for the postop care too.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

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