Wiki Modifier for retire surgeon

[LLRodgers]

Hello,

Can anyone tell me if there is a modifier I should be using if the surgeon who did the surgery retired after the surgery and the patient is following up with our doctor.

The patient is new to us, is there a modifier I should put on the E/M code?

Thank you,
Linda

 

[deborahcook4040]

not on an E&M code. What SHOULD happen is the surgeon should have coded the surgery CPT code with modifier 54 (surgical care only), and your provider should code the same surgical CPT code with modifier 55 (postoperative care only). If you can check with the retired surgeon's billing staff, that is the correct way to bill this. This insurance company would split the global surgical fee between the 2 providers. If you can't check, or if they billed it incorrectly, then I would just bill as regular E&M's, no modifier.

I'd bet they billed it incorrectly - it's an obscure modifier set.

 

[LLRodgers]

Modifier for retired surgeon

Thank you so much for the information, however I have a question regarding this.

If this was done incorrectly and I do a straight E/M code what diagnosis code do I use? Say this was a fractured ankle and they did an ORIF can I code the fracture again? Can I use a V code (aftercare)?

If they retired surgeon did put a modifier 54 on his code but we never got a transfer (and probably will not get one) can we still use modifier 55 if we have no transfer of patient?

Thank you,

Linda