Orthopedic Coding Alert

Question: Our orthopedic surgeon is seeing a patient for follow-up visits after care from another physician. We're billing office visits, but Medicare denies the claims even when we included modifier 55 for postoperative management only. How should we handle this situation?Florida SubscriberAnswer: Verify the surgical procedure and CPT code reported by the initial surgeon so you can include the same code on your claim with modifier 55 (Postoperative management only) attached to that surgical code. Your physician should be paid approximately 20 percent of the allowed amount for the primary CPT code reported. No E/M code: Postoperative visits related to the surgery are included in the surgical procedure code, so don't bill an office visit such as 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient ...) or 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...). [...]