Neurosurgery Coding Alert

Question: Can a consulting neurosurgeon charge for postoperative visits when another surgeon performed the surgery or admitted the patient to the hospital? Our surgeons are under the impression that no physician should bill post-op charges, but I disagree. Which of us is correct?


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Answer: If another surgeon asks for the neurosurgeon's opinion about a specific problem during the postoperative period of a surgery the requesting surgeon performed, you can report the service as a consultation (99241-99255). This is technically true even if they are part of the same specialty and same group practice, although the medical necessity for same-specialty/group consultations would be extremely difficult to support.

Alternative: If, however, there is no specific reason and the other surgeon is asking the neuro-surgeon to provide the postoperative care, it would be a transfer of care. In that case, you cannot report a consultation code.

Modifier rundown: For the dates he was responsible for the patient's postoperative care, the neurosurgeon should append modifier 55 (Postoperative management only) to the surgical procedure code if he assumes a patient's postoperative care from a physician in a separate practice.
 
The surgeon who performed the procedure would bill for the surgery with modifier 54 (Surgical care only) to show that your physician performed the postoperative care. He would also report the procedure code with modifier 55 for any dates he was responsible for postoperative care.