Podiatry Coding & Billing Alert

Question: My podiatrist saw a patient from a winter vacation in Colorado where she has received foot care from another podiatrist in that area. I'm thinking of appending modifier 55 to a suture removal procedure that my podiatrist did. Is this modifier appropriate?

Answer: Modifier 55 (Postoperative management only) isn't necessarily wrong, but it may get you into some coding challenges if you're not careful.

Why: CPT does allow modifier 55 to identify the postoperative management when a different physician performed the surgical procedure, but this method is difficult for carriers to track.

If you append modifier 55 to the original procedural code, the Colorado podiatrist has to use modifier 54 (Surgical care only) on the same code. The two physicians must also form an agreement on the coding and transfer of care.

Alternative: Because of the complexity of reporting modifier 55, the physician following up in these cases often chooses to report the appropriate E/M codes. Remember, experts recommend using modifier 55 only if you're on sufficiently congenial terms with the other podiatrist and to be sure that he will use modifier 54. Also be sure to use the date you first see the patient as the "from date" and the end of the global period as the "end date."