Radiology Coding Alert

Question: Should we report E/M codes or a surgical code with modifier -52 when our interventional radiologist assumes the postoperative care of another surgeon's IVC filter placement?


New York Subscriber

Answer: The solution depends on whether your radiologist takes over care from a physician in your practice or in a separate practice.

Append modifier -55 (Postoperative management only) to the surgical procedure code if your radiologist assumes a patient's postoperative care from a physician in a separate practice.

The physician who performed the IVC placement should report the same procedure code (37620,  Interruption, partial or complete, of inferior vena cava by suture, ligation, plication, clip, extravascular, intravascular [umbrella device]). But he should also add modifier -54 (Surgical care only) to show that your 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 for the example you give.

You should only report an E/M code (99231-99233, Subsequent hospital care, for inpatients, 99211-99215, Office visit, for outpatients) in the rare case that your radiologist treats a separate problem, unrelated to the original surgery.

Don't append any modifiers if the radiologist assumes postoperative care from a physician within your practice. Simply report the IVC filter placement using your practice's identification number, and your practice's other physician's postoperative care will be included in the reimbursement.

Watch for: The above is true only during the global period for the surgical service provided. You may separately code and bill E/M services provided outside the global period or for a diagnosis that is separate from the original surgical service if your documentation clearly supports this move.