Wiki Modifier 54/55

[cmrq866]

One of my surgeons wants to bill daily hospital visits with modifier 55 because one of the other surgeons did a procedure and then left town. Is this correct???

 

[Mojo]

No, modifiers 54 and 55 are appended to procedures, not E/M encounters. The inpatient visits related to the procedure are included in the global surgical package.

When you posted the other surgeon left town, did you mean temporarily or will the surgeon no longer care for the patient requiring a transfer of care to your surgeon?

 

[cmrq866]

no the physician left for vacation. I know before I used modifier 55 with another doc did the c-section and my family doc did the post partum. where does it state 55 is for procedure only?

 

[Mojo]

no the physician left for vacation. I know before I used modifier 55 with another doc did the c-section and my family doc did the post partum. where does it state 55 is for procedure only?

Complete descriptions of modifiers are located in Appendix A of the CPT manual.

55 Postoperative Management Only: When 1 physician performed the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number.

From Highmark Medical Services:

https://www.highmarkmedicareservices.com/claims/coding/modifiers/modifiers.html