Modifier 55 | Postoperative Management Only Explained

Modifier 55 describes postoperative management only, which is one of the three components of a surgical package. In this article, we will explain modifier 55, including its definition, when to use it, documentation requirements, billing, common mistakes, related modifiers, and tips for medical coders.

1. What is modifier 55?

Modifier 55 represents postoperative services, which is the third component of a surgical package. It is used when the provider renders postoperative management but does not provide preoperative or intraoperative services. This modifier is appended to a procedure code to indicate that a different provider rendered the postoperative management services.

2. When to use modifier 55?

Modifier 55 is used when different providers perform different components of a surgical procedure. It is appended to the procedure code to indicate that a different provider rendered the postoperative management services. This modifier is used when the provider who performed the surgery transfers the patient’s care to another provider for postoperative management.

3. Description

The official description of modifier 55 is postoperative management only. It represents the patient’s postoperative management after surgery, which is the third component of a surgical package.

4. Examples

Examples of procedures that require modifier 55 include a patient who undergoes a surgical procedure and is transferred to a rehabilitation facility for postoperative care or a patient who undergoes a surgical procedure and is transferred to a different provider for postoperative management.

5. Documentation

Documentation requirements for modifier 55 include the provider’s notes indicating that the patient’s postoperative management was transferred to another provider. The notes should include the name and NPI of the provider who rendered the postoperative management services.

6. Billing

When billing for a surgical procedure with modifier 55, the provider who rendered the intraoperative services should bill for the surgical procedure with modifier 54. The provider who rendered the postoperative management services should bill for the same surgical procedure with modifier 55. Each provider will receive a percentage of the surgical package payment based on the payer’s guidelines.

7. Common mistakes

One common mistake when using modifier 55 is applying it when a different provider removes sutures than the one who placed them. In this case, it is important to coordinate coding with the ED provider to ensure that each provider correctly reports the modifiers. Another common mistake is not documenting the transfer of postoperative management services to another provider.

8. Other modifiers related to modifier 55

Other modifiers related to modifier 55 include modifier 54, which represents surgical care only, and modifier 56, which represents preoperative management only. These modifiers are used when different providers perform different components of a surgical procedure.

9. Tips

When using modifier 55, it is important to ensure that the provider’s notes indicate the transfer of postoperative management services to another provider. Coordinating coding with other providers is also important to ensure that each provider correctly reports the modifiers. Finally, it is essential to follow the payer’s guidelines for reimbursement when using modifier 55.