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Same question - post operative billing

Vera Posted Thu 23rd of May, 2013 16:31:09 PM

It has been six days since I asked a question, - the last reply I got SIX days ago, was you would get back to me soon........?

SuperCoder Answered Tue 28th of May, 2013 18:37:25 PM


We are sorry for the delay. Please note this question need specifics and we have asked the opinion from our consulting editor. We are very much working on this query and make you sure you will get the definitive answer.

I am reminding her and will post the answer soon.

Thanks for your co-operation and patience

SuperCoder Answered Thu 30th of May, 2013 22:31:03 PM

The two practices must coordinate their efforts for either party to be reimbursed correctly. Please ask the reader if the operating surgeon's practice is submitting their surgical codes with modifier 54 appended; if they are not appending modifier 54, then the practice providing the postop care cannot report the surgical CPT codes with modifier 55 appended. They will have to report the appropriate level E&M service for each postop encounter.

If the operating surgeon's practice is using modifier 54, then the postop care provider should report ALL surgical CPT codes with modifier 55 appended. Report the customary fee for each surgical CPT code and let the payer process the claim before taking any reductions.

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