I work at a provider-based facility. A physician has recently become employed at our facility after working for the other facility in the city. While at the other facility, he performed multiple surgeries on patients that he is now seeing in post-op care at our facility. To bill appropriately from our perspective, do we bill the global post-op code (99024) or do we bill the surgical code with modifier -55? The same physician performed the surgical and post-op services, but at different facilities. I'm wondering if it would matter that the facility where the surgeries were performed did not code with modifier -54 if we submit with modifier -55.
Thank you, Sara Floyd RHIT, RCC
Hi Sara Floyd:
First thank you for your question. You situation is a very common one that providers run into when they switch employers as well as when they are part of a surgical team where the appropriate modifiers are not being applied by other providers involved with the patients care. I have heard many other consultants indicate the provider should bill for the post operative services using the modifier 55 or standard E/M codes when the provider is under a new Tax ID number. I disagree with that for 2 reasons. 1. The provider already performed the services and has been paid for them under their provider number. 2. If the original billing did not specify the fact the practice was only performing the intra-operative care then they were paid for the global service (i.e., pre, intra and post operative services). So, to answer your question it would be my advise to you, that you bill with the global code 99024. Again, thank you for your question. I hope I was able to assist.
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