Modifiers

Hello. I am new to the medical billing field and have a question in regards to modifiers. Our practice referred a patient to a Retinal Specialist in Seattle Washington. Because our patient lives here in Alaska, we are providing his after care. My boss (the Doctor that owns the practice) asked me to call the Retina Specialist and ask them if they used a modifier that would allow us to bill for the patient's post care. I made the call and was told they used Modifier 26. I do not believe this is the modifier we were looking for. Would you happen to know what modifier would needed to have been added to the claim in order for us to also bill the insurance company for post care?
Thank you,
Michelle

re: Modifiers

Sounds like care should have been coordinated with the Seattle Wa MD prior to sx as they may have billed for the entire surgical package which is broken down as outlined below. You are seeking to bill for your services with modifier 55 (Postoperative Mgmt only) Your question to the other office may want to be did they bill with modifier -54 on the procedures and if not, would they be willing to submit a corrected claim to accurately report their services as your doc is managing the patient post operatively. I hope this makes sense....best wishes.

Preoperative Services: 9%
Visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures.

Intraoperative Services 81%
Services that are normally a usual and necessary part of a surgical procedure; complications following surgery - All additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room;

Post operative Services 10%
Follow-up visits within the postoperative period of the surgery that are related to recovery from the surgery; Postsurgical Pain Management - By the surgeon;Supplies; and Miscellaneous Services - Items such as dressing changes; local incisional care; removal of operative pack, removal of cutaneous sutures and staples, lines, wires, tubes, drains, casts, and splints; insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes; and changes and removal of tracheostomy tubes.

re: Modifiers

Just in case you need a description for use of Modifier 54: it is for surgical care only and is used when the surgeon provides the surgical care only without pre- or postoperative services. Fees and reimbursement should be reduced to
represent the surgical portion of the global service.

re: Modifiers

Thank you so much for the detailed response.

re: Modifiers

Thank you SO much! Yes, it all makes sense and I really appreciate your help!