Don’t Bill Transfer of Care Within the Same Global Group
Question: I work for a group of surgeons. I have a patient who underwent a surgery with one provider but has been receiving follow-up care from a different provider in preparation for a second phase of surgery. Both providers are part of our practice. Can I bill either modifier 54/55 for the second provider’s follow-up services since care has been transferred between providers? AAPC Forum Participant Answer: Appending modifier 54 (Surgical Care Only) or 55 (Postoperative Management Only), respectively, is not necessary, and is incorrect, according to Medicare Administrative Contractor (MAC) Novitas Solutions. Novitas says: “Physicians who perform the surgery and furnish all the usual pre- and post-operative work should bill for global surgical care by using the proper CPT® surgical code(s). In this situation physicians should not bill separately for visits or other services that are included in the global package. No modifier is necessary. “When different physicians in a group practice participate in the care of the patient and all the physicians reassign benefits to the group, the group bills for the entire global package. The physician who performs the surgery is shown as the performing physician. No modifier is necessary.” “Transfer of care” is this context means transferring care to a provider outside of the initial practice; the situation you’ve described is within the practice and thus part of the global package. As always, check with the patient’s respective payer to make sure you’re following its specific guidelines, even though many payers follow Medicare’s lead. Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC
