Wiki Billing during global with different surgeons in same practice

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Ccgerson

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If one surgeon does a reduction in the ED, and another surgeon in the SAME practice takes over for follow up and subsequent ORIF, how is this billed?
Is modifer 54 used for reduction, or is this modifier ONLY used when post op care is with a diffferent group?
CMS and CPT guidelines for the modifier don't specify.
Thank you!
Cindy
 
Use -54 & -55 modifiers

The ED physician would use -54 for the surgical component only.

The physician that is taking over would use the -55 modifier stating that they are providing the aftercare services.
 
Since they're in the same practice, I would bill the reduction to the first surgeon, no modifier, and then for the second surgeon I would bill ORIF with modifier -58.
 
no modifier means "Global"

If the ED physician bills without a modifier, that tells the insurance company that the physician is billing the total global package. So the other physician who is treating the patient during the post op period would not get any reimbursement since the total fee would have already been paid to the initial physician who reduced the fracture, but is not treating the patient any longer.
 
Thanks everyone. I didn't think modifier 54 and 55 were for use within the same practice. But I can't find a resource that specifies that. I'll look at CMS website again.
A surgeon was asking to not charge fracture care for a reduction done by his partner, since he would now be following up. Perhaps he thought just a closed TREATMENT was being billed, instead of closed reduction.
 
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