Outpatient Facility Coding Alert

Question: If another otolaryngologist, not the physician who performed the surgery, sees a post–op patient and admits him to the hospital during the 42–day global period, is modifier 55 appropriate?

California Subscriber 

 Answer: If another otolaryngologist takes charge of all the postoperative care of a patient within the 42-day global period, then you can claim that care by appending modifier 55 (Post operative management only) to the applicable CPT® procedure code.

Key note: Verify that the originating surgeon has done a formal transfer of care to the otolaryngologist for the postoperative care. When you complete the CMS-1500 claim form, make sure that the date of transfer is mentioned in box 19. You might have denials without documentation of the formal transfer of care. 

Good to know: If the otolaryngologist performs an episode of care, then modifier 55 is not applicable, as he is not providing all of the patient’s postoperative care. It is also important that this care is within 42-day global period. 

Know these modifiers:

• Modifier 24: You can use this modifier when coding for unrelated evaluation and management service by the same physician during a postoperative period
• Modifier 78: You can use this modifier when coding for return to the operating room for a related procedure during the postoperative period
• Modifier 79: You can use this modifier when coding for unrelated procedure or service by the same physician during the postoperative period.