Wiki shared care in same practice

[lisammy]

I am new to billing for ophthalmology. We have an optometrist and ophthalmologist in the same practice. We have gotten conflicting information on whether we can billed shared care after cataract surgery when the pt is seen back by the optometrist after the ophthalmologist does the surgery. Example: Optometrist sends pt to ophthalmologist for cataracts. Ophthalmologist performs surgery sees patient one day post op and send back to optometrist for other post op visits and refraction study. Can we use 54/55 modifiers if they are in the same practice with the same tax ID, since they are considered different specialties?

 

[Cheezum51]

Why worry about that double billing? The same total fee comes into the practice either way. Bill everything through the surgeon for simplicity. If the OD is paid on productivity, then try to figure out some way internally to give them the monetary credit for doing the post op visits.
Tom Cheezum, OD, CPC, COPC

 

[natashalage]

I am a new pro-fee coder, working for a big healthcare provider with varies specialties. My understanding is to bill post-op visits/ no charge/99024 for Ophthalmologists since they perform the surgery 90days global and to bill Optometrist services for a reimbursement Since they are 2 different specialties. My understanding ( again I am new) that -54/54 modifiers are used when it's the same specialty But a different healthcare provider/NPI etc. like pt moved to a different area after surgery and the post-op care is now provided by a different group of ophthalmologists. I am eager to learn.

 

[jules2705]

Optometrists services rendered within PO period and the same practice would still be entered as 99024 -unless the patient was being seen for reasons unrelated to the procedure, in that case you could bill E&M with a 24 modifier