Modifier 55

Postoperative Management Only. When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.

Instructions

Use when the surgeon is either relinquishing all or part of the postoperative days to another physician.

Correct Use

  • Surgeon performs part of postoperative care
    • Submit claim with two lines using same date of service and procedure code; append modifier to line 2
    • Include date span in Item 19 narrative of CMS-1500 claim form or electronic equivalent
    • Submit claim with number of units as 1
  • Physician rendering additional postoperative care
    • Submit claim with surgery date and procedure code
    • Include date span of assumed care in Item 19 narrative of CMS-1500 claim form or electronic equivalent
    • Submit claim with number of units as 1

Incorrect Use

  • Do not append when surgeon performs surgery only: no postoperative care
  • Do not append if patient is under surgeon's care for full 10 or 90 days of postoperative care
  • Do not append on ASC facility or assistant surgeons claims

Claim Coding Example

An orthopedic surgeon performs an open tibial shaft fracture (27759) and bills the surgery with modifier 54. The partial postoperative care (modifier 55) is provided by the surgeon for the initial 45 days (March 10 - April 23) and is then turned over to another physician for the remailing 45 days (April 24 - June 7).

Dr Smith (Surgeon)

Date Treatment Description CPT/Modifier Units
3/9/2016 Open tibial shaft fracture 27759 54 1
3/9/2016 Open tibial shaft fracture 27759 55 1


Comment field showing dates care provided

Dr Jones (2nd physician)

Date Treatment Description CPT/Modifier Units
3/9/2016 Open tibial shaft fracture 27759 55 1


Comment field showing dates assumed care

Resource

 

Last Updated Mon, 08 Oct 2018 09:09:30 +0000