Wiki Out of State Surgery with Local Follow Up

[grandcanyongirl22@gmail.com]

I have a claim where the patient had surgery out of state and is now seeing our local ortho doctors for a follow up visit for both conditions. Patient had a hip hemiarthroplasty due to a fracture and also has a distal radius fracture. MD is billing 99024 and 99213-24. I think I should bill 99213 because of different tax-id's. But I am wondering about 99024 because it is the same insurance company that paid for the surgery and now the follow up. I have access to outpatient visit notes from the out of state doctor but no billing information. Has anyone encountered this situation?

 

[CBLENNIE]

How long did the original surgeon provide post-op care before the patient returned home and your provider assumed the routine post-op care? Depending on how long the surgeon provided post-op care, you may be able to split the billing with the surgeon. The surgeon could bill the pre-op and surgical care as indicated by modifiers appending modifier 54-surgical care only to the surgical CPT code, as well as billing the pre-op care by billing another claim with modifier 56- preoperative management only to the surgical CPT code. Then your provider could bill the surgical CPT code with modifier 55-postoperative care only.

Then your provider gets paid for the work that they put into managing the patient's postoperative care.