Wiki Billing for procedure in postop

[CallieSowder]

our physician performed a trabectomy, and is only billing for the surgery while another physician outside of our facility is doing the postop care. Our physician billed with the 54 modifier while the other physician is using the 55 for post op care only. The patient had to have a laser suture lysis done by our physician because the postop doctor couldn't do it. How do we bill for this done in the post op by our physician when another is in charge of the post op? Do we just use a 99024 since the laser lysis is considered part of the global? Or do we need to charge for it with a modifier?

 

[danskangel313]

When the other provider agreed to provide the post-op services, which included the removal of sutures. Once that transfer of care was completed, the other provider took on all responsibilities of overseeing the patient.

The global package does NOT include "services of other physicians related to the surgery, except where the surgeon and the other physician(s) agree on the transfer of care." If you think of that in reverse, that's how I view your situation.

I'll try to explain it a different way. So there's your provider, we'll say Dr. A and the other provider, Dr. B. Once Dr. B assumed care of the patient, Dr. A was taken out of the picture for post op services. Now that your provider, Dr. A, is being called back in for suture removal, that's the equivalent to "services of other physicians related to the surgery" with no transfer of care and should not be considered bundled. If the transfer from Dr. A to Dr. B did NOT happen, then the suture removal would be bundled. Does that make sense?

IMO, you should bill for the procedure because your provider is not the one who is responsible for the post op care. No mods should be necessary.