READER QUESTIONS:
Append Modifier 55 for Post-Op Care
Published on Tue Apr 11, 2006
Question: Should we report E/M codes or a surgical code with modifier 52 when our peripheral vascular specialist assumes the postoperative care of another surgeon's IVC filter placement?
New York Subscriber
Answer: The solution depends on whether your cardiologist takes over care from a physician in your practice or in a separate practice.
Append modifier 55 (Postoperative management only) to the surgical procedure code if your cardiologist assumes a patient's postoperative care from a physician in a separate practice.
The physician who performed the IVC placement should report the same procedure code (37620, Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]). But he should also add modifier 54 (Surgical care only) to show that your physician performed the postoperative care.
Medicare's Physician Fee Schedule Database divides the percentage of relative value units into a procedure's pre-, intra- and postoperative components. Appending modifier 52 (Reduced services) to the surgical procedure tells the carrier that you performed the procedure and that the service was reduced, so this modifier isn't appropriate for the example you give.
You should only report an E/M code (99231-99233, Subsequent hospital care, per day; 99211-99215, Office visit, for established patient) in the rare case that your cardiologist treats a separate problem, unrelated to the original surgery.
Don't append any modifiers if the cardiologist assumes postoperative care from a physician within your practice. Simply report the IVC filter placement using your practice's identification number, and your practice's other physician's postoperative care will be included in the reimbursement.
Watch for: The above is true only during the global period for the surgical service provided. You may separately code and bill E/M services provided outside the global period or for a diagnosis that is separate from the original surgical service if your documentation clearly supports this move.
