Orthopedic Coding Alert

Question: The orthopedist in the operating room (OR) treats a patient sent from the emergency department (ED) for a badly injured forearm. The surgeon performs an open reduction and an internal fixation of the right ulnar shaft. Notes indicate that the patient is on vacation and not from this area, and his postoperative care will be handled by an orthopedist local to his area. How should my surgeon report his surgical services?

Colorado Subscriber

Answer: You should report 25545 (Open treatment of ulnar shaft fracture, includes internal fixation, when performed) for the surgery with modifier 54 (Surgical Care Only) appended to show that your surgeon is only performing the surgery — i.e. open reduction and internal fixation of fracture — and another physician is providing postop care.

Modifier 54 defined: Coders use modifier 54 when the provider performs a surgical procedure/service, and another provider will be performing the management of postoperative and/or preoperative treatment.

Other single-component modifiers: There are also instances where your provider might not provide the surgery, but they do provide pre- or postoperative services. In order to carve out each provider’s portion of the service, there are modifiers for those instances as well.

When a provider performs all the postop care but does not provide surgery/preop care, append modifier 55 (Postoperative Management Only) to the procedure code. So if your provider performed the postop in the example above but not the surgery/ preop, you’d report 25545 with modifier 55 appended.

When a provider performs all the preop care but does not provide surgery/postop care, append modifier 56 (Preoperative Management Only) to the procedure code. So if your provider performed the preop service in the example above but not the surgery/postop, you’d report 25545 with modifier 55 appended.