We are seeing a new patient for their post op visits only. The patient had surgery by another Provider. How do we bill this? 9920__-55 or 28585-55? What do we put in as the dos? Your help would be greatly appreciated.
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Wiki Post-op
- Thread starter smr820
- Start date
OCD_coder
True Blue
Unless you have a prearranged agreement with the surgeon and they bill with the surgical only modifier, avoid using the surgical code with modifier 55 (postop only) code.
Just bill the appropriate office E&M to for the status of the patient, new or established.
Just bill the appropriate office E&M to for the status of the patient, new or established.
mitchellde
True Blue
The problem is the surgeon , if they do not use the 54 modifier, has been paid for the post op visit already. If the surgeon referred the patient out to another provider for post op0 due to distance for the patient to travel then it is appropriate to use the 55 modifier as a transfer of care has occurred, (required whne using the 55 modifier). If the patient self refers for post op due to not wanting to return to the surgeon , this most usually must be a patient responsibility. Remember to use a post op V code and nbot the reason for the surgery.