Ob-Gyn Coding Alert

Question: When reporting 59430, should I attach modifier -55? One insurance carrier reduces our fee when I use the modifier.

Missouri Subscriber

Answer: You should not use modifier -55 (Postoperative management only) with 59430 (Postpartum care only [separate procedure]) because the code already states that this is the only service the ob-gyn performs.

You should use modifier -55 when the surgeon is charging for postoperative (postpartum) care as part of the surgical payment, but for some reason someone other than the surgeon performed the procedure. In that case, you should add modifier -55 to the surgical code. In addition, the surgeon should add modifier -54 (Surgical care only) to the same surgical code to show that he or she did not provide post-op care.