• The physician who performs one day of preoperative care, intraoperative care, and any in-hospital visit performed on the day of surgery should report the 54 modifier.
• The physician who performs only the postoperative care should bill with the date of the surgery, procedure code for the surgery, and a 55 modifier.
• The total number of days reported in Physician A and B's ranges should equal the total number of postoperative days for the procedure.
• In those cases where postoperative care is "split" between physicians, the billing should be reported as:

Physician A

• Line 1 – date of surgery, surgery code with 54 modifier
• Line 2 – date of surgery, surgery code with 55 modifier

Narrative Field or Item 19

Range of dates that the postoperative care was provided. If the physician (surgeon) does only one day of post-op care, then he needs to put 10/21/2004 to 10/21/2004 or "one day of post-op care" in Item 19 or narrative equivalent.

Physician B

Date of surgery as service date, surgery code with 55 modifier, and range dates when responsible for post-op care.

EXAMPLE

An ophthalmologist (Dr. A) performs cataract surgery (66920) on October 10, 2004 and performs three days of postoperative care. The optometrist (Dr. B) then takes over the care of the patient for the remainder of the post-op period.

Posted: 10/18/2004