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tci Medicare Compliance & Reimbursement - 2008 Issue 1

Part B Coding Coach: Report Co-Management Correctly With Mods 54 And 55

You're in for a world of denials if you miss this coordination tip If your physician is co-managing a patient's case with another physician, you may be tempted to automatically apply modifier 54 or 55, depending on your physician's work. If you're not careful, however, you could be raising a red flag with Medicare and your other payers.Key points: Make sure you append a co-management modifier only when both physicians share the patient's care, and ensure that you're performing the co-management service for the patient's benefit, not for the practice's financial benefit. Your physician needs to document the...

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