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help with modifier 55

Renee Posted Tue 14th of March, 2017 12:10:02 PM
How do we bill claims for postoperative follow up care if we do not have a written "transfer of care" notice from the provider who did an operation? we have many patients who are injured while out of town, then come back home & need to follow up. do I still bill the operative cpt code with the -55 mod & indicate the primary surgeon & list the post op care dates? or do I bill as a new patient with an E&M code? thank you
SuperCoder Answered Wed 15th of March, 2017 06:00:13 AM

Hi Renee,

Where a transfer of care does not occur, occasional post-discharge services of a physician other than the surgeon are reported by the appropriate E/M code. No Modifiers are necessary on the claim. Please follow the link below for further clarity. Thank you.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf

Renee Posted Tue 21st of March, 2017 14:28:59 PM
is this a choice that the provider has? whether to bill the surgical code with a -55modifier OR to bill office visits with xrays? or is it simply that the appropriate coding for assuming care after a surgery is to bill post op care only? thanks
SuperCoder Answered Wed 22nd of March, 2017 13:32:21 PM

If we do not have written documentation of "transfer of care", it is appropriate to bill E/M with xrays. Patient service would be considered as new patient E&M. However, if  "transfer of care" is documented, we will use modifier 55 with the CPT procedure code for global periods of 10 or 90 days. Thank you

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