Wiki Follow up after surgery

[JCampbell]

How would you bill Medicare if a patient has surgery by a physician and is then seen by a physician who is not part of that surgeons group?

Thanks!

 

[nanettehei]

After surgery

It would depend on if the patient is seeing a different physician for an unrelated problem.
If the patient is in the global surgery days and the problem is NOT the same you can bill with a modifier.

 

[dclark7]

If the physician is not part of the surgeons group and there is no transfer of care, you just bill an E/M code, no modifiers. If the surgeon has transferred care to your physician (this must be documented in both the original physician's chart and your chart that transfer has occurred) then you would bill the surgical code with a 55 modifier and the surgeon would bill the surgery with a 54 modifier.

 

[JCampbell]

Normally what happens is the physician who is not part of our practice performs the surgery at our local hospital. The physician who performs the surgery only comes to the hospital once a week for clinic/surgeries; therefore our physicians then take care of the patients.

 

[FTessaBartels]

Modifiers 54 and 55

Normally what happens is the physician who is not part of our practice performs the surgery at our local hospital. The physician who performs the surgery only comes to the hospital once a week for clinic/surgeries; therefore our physicians then take care of the patients.

The surgeon performing the surgery should be using a -54 modifier (*surgical care only*) on the relevant CPT codes.

The surgeon (different practice) who are doing the follow-up should be using the exact same CPT codes as the operating surgeon but with -55 modifier (*postoperative management only*)

Your practice should make it absolutely clear to the operating surgeon that this is the way these services will be handled, if the operating surgeon expects his patients to be cared for in the post-op period. Otherwise the operating surgeon is being reimbursed for services s/he is not providing.

Hope that helps.

F Tessa Bartels, CPC, CEMC