Resolved Modifier 54

[ViktoriyaR_11646]

Hello,

Can physicians who perform emergency room services bill modifier 54 when billing for surgical procedures?

Thanks,

 

[Lori]

The use of modifier 54 indicates the surgeon has transferred postoperative care (partial or total) to another provider, and the surgical code with modifier 55 appended will be billed by the receiving provider to whom the postoperative care was transferred

Appropriate Usage of Modifier 54​

• When the surgeon transfers all or part of the post-op care to a provider outside their group
• Append to the surgery procedure code with a 010 or 090-day post-op period
• Applies when the surgeon fully transfers critical care services to another provider

Inappropriate Usage of Modifier 54​

• Appending modifier 54 to a surgical procedure
  • Without a global period or
  • With a global period other than 010 or 090
• When the covering provider belongs to the same group
  • This can include fee-for-time compensation arrangements
• Appending to an Evaluation and Management (E/M) procedure code
• Appending to an assistant at surgery service

All medical procedures that include a “global period” are comprised of three parts: pre-operative services, intra-operative services (e.g., performance of the actual surgery/procedure), and post-operative care (related follow-up visits during the 10- or 90-day global period). If a physician does not perform all three parts of the service, compliant coding dictates that you append modifier 54 Surgical care only, modifier 55 Post-operative management only, and modifier 56, as appropriate.

Medicare Won’t Accept Modifier 56

Modifier 54 (and Modifier 55) Mastery

When a provider performs only a portion of the global package, compliant coding dictates that you consider modifier 54, modifier 55, or modifier 56.

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