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Modifier 55

Vicky Posted Wed 22nd of June, 2011 15:31:25 PM

Just making sure I am using this modifier correctly. Patient had surgery (appendectomy) out of state and is having post operative management at home. Surgeon would bill appy code with 54 modifier and we would bill appy code with 55 modifier. Different scenario. Pt has gyn surgery and has post operative complication of non-healing wound for which she is referred to wound clinic to treat. Would the wound clinic physician bill as consult and debridement or would wound clinic physician bill surgery code with modifier 55. Question 55 modifier because post operative management not for gyn problem but for different issue. Appreciate any comments on this.

Nikhil Answered Wed 22nd of June, 2011 19:43:14 PM

Case 1: Modifier 55 usage is correct.
Case 2: Modifier 78 applicable.

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