EM Coding Alert

Question: A physician of mine diagnosed a hip fracture and performed the surgery here in Florida, where the patient had been vacationing. She then released the patient, who went back to his home in Georgia, where a different physician performed all of the postoperative care. Can both physicians collect for their portions of the global surgery fee?

Florida Subscriber

Answer: If both physicians provided services within the global surgical period, the post-op, post-discharge care is split among the two physicians when they agree on the transfer of care. 

According to CMS, “When more than one physician furnishes services that are included in the global surgical package, the sum of the amount approved for all physicians may not exceed what would have been paid if a single physician provided all services, except where stated policies allow for higher payment.”

Never: “When the surgeon furnishes only the surgery and a physician other than the surgeon furnishes pre-operative and post-operative care, the resulting combined payment may not exceed the global allowed amount,” continues CMS.

With an agreement of transfer care during the global period, the services will need to be distinguished with the use of an appropriate modifier:

• Modifier 54 (Surgical care only) 
• Modifier 55 (Postoperative management only)
• Modifier 56 (Preoperative management only).

The written transfer agreement must be in the patient’s medical records. If there is no transfer of care, another physician may be paid separately or denied for medical necessity reasons depending on the circumstances. 

The two physicians must bill the same procedure code using modifiers 54, 55, and/or 56. The date the surgical procedure was performed and the surgical procedure code should be reported on the bill for the preoperative care, the surgical care, and the post-op care.

Although the postoperative care is usually delivered in the form of office visits (which would normally be billed with an E/M code), the rendering physician’s coder would actually use the surgery code with modifier 55.