Wiki Co-Managed Billing bilateral done on separate days

[Irmbllc20]

I am looking for a little clarification on how to appropriately bill co managed claims. Our surgeon performs some of the post op care. example

Patient A has cataract surgery on 02/09/21 for OD eye, patient is seen in our office for PO visit next day 02/10/2021 for PO day 1 on OD eye, patient is scheduled for 2nd surgery OS eye and cataract surgery is done 02/16/2021 OS eye patient is seen for PO care on OS eyes on 02/17/2021. and is continued to be seen for OU eyes during that time until 03/01/2021 when care is relinquished to Optometrist 03/02/2021.

Do I have to wait to bill the surgeries with the co managed days on one claim? Or would I bill the surgeries like normal with the 54 mod and when PO care is relinquished go back and bill the co managed days with a 55 modifier? What I am thinking is this example below;

02/09/2021 66984-55-RT-LT Listed in box 19 ( Post-Op care performed 02/10/21-03/01/2021-20 days) Is that correct?

Or should it be broken out like example below;

02/09/2021 66984-55-RT listed in box 19 (Post-Op care performed 02/10/2021-02/15/2021-5 days)
02/16/2021 66984-55-LT listed in box 19 (Post-Op care performed 02/17/2021-03/01/2021- 12 days)


Thank you in advance

 

[thomas7331]

The guidelines for modifier 55 say that it should be billed with the date of the surgery, so your second example is correct (except that you'll need to add a modifier 79 on the 2/16 service).

If you bill the bilateral procedure on 2/9, it's not only incorrect reporting, but will also cause your global period for left side to encompass the wrong dates, and your reimbursement will be reduced in error because there will be a multiple procedure adjustment to the payment as if both procedures had been done on the same day.

Your scenario is a little unusual in that is sounds like you are splitting the post-operative care between providers. Who is billing the 55 modifier then if the care is 'co-managed'? Normally that modifier is used only by the provider to whom care is being transferred.

 

[Irmbllc20]

The guidelines for modifier 55 say that it should be billed with the date of the surgery, so your second example is correct (except that you'll need to add a modifier 79 on the 2/16 service).

If you bill the bilateral procedure on 2/9, it's not only incorrect reporting, but will also cause your global period for left side to encompass the wrong dates, and your reimbursement will be reduced in error because there will be a multiple procedure adjustment to the payment as if both procedures had been done on the same day.

Your scenario is a little unusual in that is sounds like you are splitting the post-operative care between providers. Who is billing the 55 modifier then if the care is 'co-managed'? Normally that modifier is used only by the provider to whom care is being transferred.

Yes, both providers are splitting the post op care. The surgery done on 02/16 was billed with 79 modifier. Or were you meaning it needed to be assigned to the post op care reporting as well?

 

[thomas7331]

Yes, both providers are splitting the post op care. The surgery done on 02/16 was billed with 79 modifier. Or were you meaning it needed to be assigned to the post op care reporting as well?

I believe most payers will require you to use modifier 79 on the post-op care as well, otherwise the two global periods designated by the two charges with modifier 55 will overlap.

If you have multiple providers performing part of the post-op care, which one is billing with the modifier 55? Are you billing under one provider and then allocating part of the payment to the other?