Radiology Coding Alert

Question: Our interventional radiologist recently took over the postoperative care of another surgeon's IVC filter placement. Should we report E/M codes for these visits, or the surgical code with modifier -52 appended?

New York Subscriber

Answer: If your radiologist assumes a patient's postoperative care from a physician in a separate practice, you should report the code for the surgical procedure and append modifier -55 (Postoperative management only).
 
The physician who performed the IVC placement should bill the same procedure code (37620, Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]) with modifier -54 (Surgical care only) appended to indicate that another physician performed the postoperative care.
 
Medicare's Physician Fee Schedule Database divides the percentage of relative value units into a procedure's pre-, intra- and postoperative components. Appending modifier -52 (Reduced services) to the surgical procedure tells the carrier that you performed the procedure and that the service was reduced, so this modifier isn't appropriate in your scenario.
 
You should only report an E/M code (99231-99233 for inpatients, 99211-99215 for outpatients) in the rare case that the radiologist treats another problem, unrelated to the original surgery.
 
In this case, you would append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code.
 
If you assume postoperative care from a physician within your practice, it would not be necessary to append any modifiers. You would report the IVC filter placement using your practice's identification number, and your practice's other physician's postoperative care would be included in the reimbursement.