Friday, April 30, 2010

Where to use CPT modifer 54

Surgical - 54 Modifier

54 Surgical Care Only: When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding the modifier 54 to the usual procedure code.

Services billed with a 54 modifier will be reimbursed at the intraoperative allowance for the surgical procedure. The intraoperative allowance includes the one day preoperative care, the intraoperative service, as well as any in-hospital visits that are performed.



Instructions

Modifier 54 is used 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 modifier 54 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)
Date     Treatment Description CPT/Modifier Units
3/9/16 Open tibial shaft fracture 27759 54 1

Split care (Transfer of Care)

*Surgery care only (54)

*Surgeon is performing only the preoperative and intra-operative care

*Modifier is only used on surgical codes

*Commonly used with ophthalmology specialty


*Postoperative management only (55)

*Physician, other than surgeon, assumes all or part of postoperative care

*Copy of written transfer agreement must be kept in beneficiary’s medical record


MPFS Component of Split Care


*The MPFS shows the pre, intra and post operative percentage

*Providers should review the MPFSDB for their specific code and applicable percentage

*System calculates allowance based on fee schedule amount multiplied by percentage rate

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