tci Part B Insider - 2007 Issue 41

Part B Coding Coach: Expert Tips Ensure You Apply Modifiers 54 and 55 Correctly

You-re in for a world of denials if you miss this coordination tipIf 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 reason...

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