Cardiology Coding Alert

Question: Often, when our cardiac surgeon performs a surgical procedure, another cardiologist in our practice manages the postoperative treatment. Typically, we append modifier -54 to the surgical code and modifier -55 to the cardiologist's postoperative care code. We were recently advised that we should append modifier -55 to the surgical code to identify postoperative care. Is this correct?

Texas Subscriber

Answer: Yes. You should append modifier -55 (Postoperative management only) only to a surgical code, even though the term "postoperative management" does not refer to a surgical procedure and begins only after the surgery is completed.
 
The Physician Fee Schedule divides the percentage of relative value units (RVUs) into a procedure's pre-, intra- and postoperative components. Many cardiac surgeries are assigned as follows: pre-op, 9 percent; intra-op, 84 percent; post-op, 7 percent.
 
Appending modifier -54 (Surgical care only) to the surgical procedure tells the carrier that the cardiac surgeon performed only the intraoperative portion of the procedure. In such cases, the surgeon will likely receive 84 percent of the RVUs assigned to the procedure.
 
The cardiologist, meanwhile, reports the same surgical code with modifier -55 appended and receives 7 percent of the value of the procedure. The cardiologist can use an E/M code only if he is treating another problem, such as syncope (780.2) or postoperative atrial fibrillation. In this case, you would append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code.
 
Very few carriers will pay for preoperative management when another physician performs the service, even when you report modifier -56 (Preoperative management only) appropriately.

 - You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, CHCC, CPC, president of Compliant MD Inc. and compliance manager for several cardiology groups around the country, and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.