Wiki post op visit

[diann]

Can/Should I bill a post op visit with modifier 55 if the surgeon bills the surgery with a modifier 54. Here is the scenario...surgeon (specialty physician) has his office in another city. He does his surgeries at the hospital by his office there. He does his post-op visits here at my facility which is totally unrelated to his other facilities. I just had an auditor say that as long as he bills his surgery with a modifier 54, than I can bill the post-op (with-in the global for that surgery) with a 55 and I can get paid with that. Otherwise if he doesn't use a modifier 54 than I have to write off the post-op visit since it is covered under global. I know that rural health has no global periods but for other insurances.....I even say for the rural health I should not be billing an E/M visit (i.e. 99213 etc) but I was told that since it is same physician but different NPI it shouldn't matter. I need help on this one.
Thanks,
Diann DoBran CPC, CPC-H

 

[OCD_coder]

I hope I am reading this post correctly???

If the same physician has performed the surgery and then is performing the postop visit in another city/facility. His NPI# is going to be the same and they cannot "fracture" the billing of surgical procedures to recieve payment for the Sx and postop care by the same physician. Whom ever is billing for the patients surgery should be billing the global package with no modifier and the postop visits are not billable with a postop modifier or separate E&M.

If the postop visit(s) is by a different physician all-together, different NPI, different Tax ID# and the surgeon is using Sx care only modifier 55 then I would be comfortable defending use of postop care only 55 for the non-surgeon. What should be documented in both providers patient recrods is a transfer of care document/letter/note; see source below for Transfer of Care informatoin.

http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf

 

[diann]

Thank You, Thank You, Thank You!!!! I have been saying this all along and was told I was wrong! When these auditors told us to use the modifier I was like what!!! Thank you!

Diann