Removal of orthopedic hardware

A patient who had an external fixator applied in Florida while on vacation, needs follow up care and removal under anesthesia (20694) when she returns home
to NJ. She is a new patient to our practice. This is a Medicare patient. Do I need to apply a modifier to the surgical code? Modifier -55 seems to apply to post op management but does that include procedures? Modifier -78 return to OR for related procedure might be better. My modifier book says it should be used if same physician returned to OR. I could use some help.
Thank you,
Ellen Post

Follow-up fracture care/fixator removal

You would have to know the code for the surgery in Florida. Modifier-55 would be appended to that code for the initial aftercare visit. This will pay her/him for the work of seeing a surgical patient without having done the surgery.

Any other routine follow-up visits would not be billed because they would be considered to be a part of the global period.

The description of modifier -78 shows same physician so that one would not be used by the NJ provider.

Hopefully, the surgeon in Florida reported that service with modifier-54 so that your provider's claim is not denied. If it is, you'll need to get in touch with them and have them resubmit a claim. If you get a claim in first, your's should be paid and Florida's would be denied if not coded with modifier-54 and possibly -56.

Such a game!