Modifier 54 and modifier 55

March 21st, 2009 - Codapedia Editor
Categories:   Coding   Modifiers   Surgical Billing & Coding  
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The global surgical package includes the care of the patient pre-operatively, intra-operatively and post-operatively.  In some cases, however, the surgeon has performed only part of those services.  For example, a tourist at a ski resort who falls and requires surgery will return to their own home for their post op care.  The surgeon who provides the emergency surgery will only perform the surgical component.  In rural areas, patients may have surgery at a tertiary care center, but arrange to have their post-op management closer to their own home.

When billing for the global surgical package, no modifier is applied to the CPT® code.

When billing for only a component of the service, use modifier 54 to indicate that only the srugical care was provided and modifier 55 to indicate that the post-op management alone was provided.  Both surgeons use the same CPT® code. The surgeon who performs the surgery puts the date of service of the actual surgery on the claim form.  The surgeon who accepts the patient in transfer and provides the post-op care, use the date of service the care was assumed.  The surgeon who assumes the post-op care may not bill until the  that surgeon has provided one service.  For Medicare patients, a written transfer of care agreement must exist.  This could be in the form of a letter in the medical record, transferring the care of the patient.

 

 

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