Wiki Out of State Surgery came home for FU

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LLRodgers

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Can someone please, please help me!

I have a patient who fractured her ankle in Tennessee and had surgery in Tennessee, she is 13 days out of surgery and came home to PA and had a fu visit with our Orthopedic doctor.

How do I code the Fu with us, it is the first time we are seeing her for this. I coded the Fracture with their Surgery code with RT-55.

It is being denied: Missing/Incomplete/Invalid days or units of service - not sure what that means.

Can anybody help me?

LLR
 
If you are going to bill the post-operative care only with the modifier 55, you'll need to bill it for the same date of service as the original surgery, not for the date of the follow-up visit. Also, in order for it to be paid, the original surgeon would have to have billed their surgery with a 54 modifier, and technically there should also be a transfer of care agreement in the records.

However, if the surgeon has billed and been paid for the full surgical package and there was no formal transfer of care, and your practice is only going to be providing limited follow-up care, you may want to consider just billing the E&M services - CMS gives guidance that "Where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate E/M code. No modifiers are necessary on the claim."
 
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