Wiki 54 modifier

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missyah20

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Hey all,
I am hoping that someone may be able to help me with this. I do not do a lot of surgical billing, but we have recently acquired a surgeon. He does bill a lot of his surgeries with a 54 modifier, but then he has seen the pt back in about a week (to remove the staples etc) and he wants to bill for these visits. Can we do that since he has billed the surgery with a 54? Wouldn't they be included in the charge for the surgery?

Thanks!
 
Why use 54?

Why is he using a -54 modifier if he is going to see the patient post-operatively?

He cannot simply use it to unbundle the pre- and/or post-op care.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
I agree with Tessa. He cannot bill for things that are routine post operative care. I work for a large group of general surgeons. We have never used a -54 modifier. And do not charge for follow up care unless there is a complication that leads to surgery.
 
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