Post operative management

Senario: Dr.A (on call for Trauma) Pt. come in ER stabbing(horizon ins.). surg is needed.Dr. A performs Ex Lap cpt 49000. Day one post op Dr. B (Trauma Team) now is managing pt. care until discharge. Can Dr. B bill for postopertative managment and if so which cpt?

Per our coding team yes, Dr. B will bill the same surg. cpt 49000 with a modifier 55 and she directed me to this link http://www.aafp.org/fpm/20001100/coding.html 3rd question on Postoperative management.

Dr. A is not part of the trauma group, he sometimes take call for trauma. Both share the same tax idd(which i don't think matters because they are not in the same group). It seems to me that because Dr.B is now caring post surg. that billing a subsequent would be the correct coding 99231 - 99233 with modifier 55 instead of billing the surg. code because they had no part in the surg. and Dr. A should be bill the surgl procedure with modifier 54 to indicated that he did not provide the entire global package.

Post Operative Management

CPT appendix A-Modifiers gives direction on this issue

55 Postoperative Management Only: when 1 physician performed the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the ususal procedure number.

54 Surgical Care Only: When 1 physician performs a surgical procedure and another provides the preopertive and/or postoperative management, surgical services may be identified by adding the modifier 54 to the ususal procedure number.

I interpret the "usual procedure number" to mean the surgery code. I see how one could interpret it as the E&M visit.
But we have always done it using the surgery code. It seems like CMS should be able to provide you with clarification. Have you checked you carrier web site?

Louise

Post operative management

Not yet. but i just does not seem correct to bill the surg. cpt coded for dr. B..to me it would seem like Dr.B had part in the surg.procedure..when he did not..he his only manageing post care...

Post Operative Management

Yes, you can't bill a surgery code for Dr. B, just bill 99231-99233 with modifer 54.

Modifier -54

Modifier 54 is a surgical split global modifier and cannot go on an E/M code. Modifier 54 is used on the surgery code when the surgeon performs the pre-op visit, the surgery and the hospital visits. Modifier -55 is used when post-op care is transferred to another physician, that physician bills the surgical date and code for surgery and the -55 modifier after the first post-op visit following hospital discharge.