54 - JE Part B

Surgical Care Only. When a physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding this modifier to the usual procedure code.

Instructions

Use to explain that the surgeon performed the surgical procedure only and is relinquishing a part or all of the postoperative days to another physician.

Correct Use

• Surgeon performs surgery only
  • Bill surgical date of service
  • Append to surgical code

Incorrect Use

• Do not append modifier 54 if patient is under surgeon's care for the full 10 or 90 days of postoperative care
• Do not append on ASC facility or assistant surgeons services

Claim Coding Example

An orthopedic surgeon performs an open tibial shaft fracture (27759) but relinquishes care to another physician for postoperative care.

Dr. Smith (Surgeon)

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 40.2