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Modifier 55

Chery Posted Wed 29th of August, 2012 18:48:00 PM

My physician is seeing another physician's post op. Can I charge for an exam w/mod 55? What CPT can I use?

SuperCoder Answered Wed 29th of August, 2012 19:08:48 PM

If the original surgeon became unavailable immediately after performing a procedure, and the substitute performed the majority of the follow-up care and doesnt have an arrangement with the unavailable neurosurgeon, he or she may be able to bill for this by attaching modifier -55 (postoperative manage-ment only) to the code for the procedure performed.

For example, the covering neurosurgeon could bill for a follow-up office visit with a patient who had intracranial aneurysm surgery performed as a 61700 with modifier -55 attached to show that the visit was for postoperative management. Such a claim may not be paid unless the office of the neurosurgeon who performed the procedure agrees to attach modifier -54 (surgical care only) to the original service, indicating that postoperative care would be handled by another physician. In these cases, the fee charged by the original neurosurgeon should be reduced to reflect the fact that postoperative services are not included.

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