Wiki modifiers and post op f/u by assistant surgeon

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Tammy Hughes

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Surgeon was an assistant surgeon on a recent case. Primary surgeon left for vacation and patient was re admitted to hospital several days after his discharge.. My doctor is now consulting on this patient who was in the hospital for 19 days.
As he was not the primary surgeon I should be able to bill for these visits correct? Triwest is not paying stating these services were performed within the global period of another service. Even though my doctor was not the primary surgeon.
Would it be appropriate to use modifier 55 for post operative management? Thoughts? Thanks in advance.
 
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If the two surgeons are of the same specialty and with the same practice, then for all practical purposes with payers they are treated as if they were the same person and any care that is related to the procedure in the global period would be considered inclusive and not separately payable. (If the care is unrelated, you can apply a modifier 24.)

If the two are in separate practices, then a transfer of care can be done, in which case the surgeon performing the procedure would bill modifier 54 for the intra-operative work and the surgeon performing the post-operative care would bill the same procedure with modifier 55 to indicate post-operative care only. Modifier 55 would not be appropriate if there has not been a transfer of care and if the original procedure was not billed with the 54 modifier.

If neither of these situations apply, and these visits are related to the procedure, then it's the responsibility of the surgeon who was paid for the procedure to cover the costs of the post-operative care, and that surgeon should be reimbursing the other provider who is covering for him/her while on vacation.

The CMS global surgery booklet here will give you more detail on all of this:
 
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