Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

billing for post op care only

Vera Posted Thu 13th of December, 2012 19:44:08 PM

when you bill for post op care only, the dr that did the surgery must include a 54 modifier and we must include the 55 ... with that being said,... what code do i bill the post op care for ? 99213 office visits? w/ a 55 ... or the CPT code of the surgery that was performed at other office with a 55 ?? what $ amount do you bill ? the surgical amount or the 20% ? very confused.

Vera Posted Thu 13th of December, 2012 19:50:45 PM

when you bill for post op care only, the dr that did the surgery must include a 54 modifier and we must include the 55 ... with that being said,... what code do i bill the post op care for ? 99213 office visits? w/ a 55 ... or the CPT code of the surgery that was performed at other office with a 55 ?? what $ amount do you bill ? the surgical amount or the 20% ? very confused.

Vera Posted Thu 13th of December, 2012 19:51:27 PM

what does this mean?
"Please put code in between backtick characters" ???

SuperCoder Answered Fri 14th of December, 2012 21:42:49 PM

Where physicians agree on the transfer of care during the global period, services will be distinguished by the use of the appropriate modifier:
• Surgical care only (modifier “-54”); or
• Post-operative management only (modifier “-55”).

For global surgery services billed with modifiers “-54” or “-55,” the same CPT code must be billed. The same
date of service and surgical procedure code should be reported on the bill for the surgical care only and postoperative care only. The date of service is the date the surgical procedure was furnished.
Modifier “-54” indicates that the surgeon is relinquishing all or part of the post-operative care to a physician.
• Modifier “-54” does not apply to assistant at surgery services.
• Modifier “-54” does not apply to an ASC’s facility fees.
The physician, other than the surgeon, who furnishes postoperative management services, bills with modifier “-55.”

Use modifier “-55” with the CPT code for global periods of 10 or 90 days.

• Report the date of surgery as the date of service and indicate the date care was relinquished or assumed. Physicians must keep copies of the written transfer agreement in beneficiary’s medical record.
• The receiving physician must provide at least one service before billing for any part of the postoperative care.
• This modifier is not appropriate for assistant at surgery services or for ASC’s facility fees.

Related Topics