Wiki HELP!! Billing E&M's after the 55 modifier

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sandya

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Hi...if we are the group billing the 55 modifier, post op care only, can we still bill for subsequent care codes during that same inpt stay, as long as the care has been immediately transferrred to us? If the pacer was inserted on 10/1/14 33208-55, can we bill for the subsequent care codes for 10/2, 10/3 and the discharge on 10/4? Please advise!! We are in a state of confusion all of a sudden. thanks Sandy
 
Ok, I was told that meant after the hospital, follow up in the office only. so, then billing with the 55, is payment for all the aftercare???
 
Hi...so the reimbursement we get from billing the procedure with the 55 modifier, is in place of billing for the aftercare visits. I just want to understand this!! thank you Sandy
 
sandya said:
Hi...so the reimbursement we get from billing the procedure with the 55 modifier, is in place of billing for the aftercare visits. I just want to understand this!! thank you Sandy
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Yes, this is correct. The RVU file shows the breakdown, by percentage, of each surgery code for pre-op, intra-op, and post-op, care.
 
Yes in most cases the 55 modifier is 10% of the surgical allowable. So if the global surgical allowable is 1000 then you get $100 for all the post operative visits. For some payers and some procedures this may be as much as 15% and rarely 20%.
 
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