tci Part B Insider - 2010 Issue 6

YOUR PART B QUESTIONS ANSWERED: Modifier 55 Goes on Original CPT Code

Question: One of our patients went to the emergency department (ED) for a laceration to his head that occurred on a weekend. He had sutures put in and was told to follow up with us in 7-10 days. At the office visit, the provider removed the sutures, cleaned and rebandaged the area, and spoke with the parent about wound care. I filed to insurance as 99213 with modifier 55, which the insurer paid at $15. Was the modifier incorrect? Answer: You used the correct modifier but the wrong CPT code. You should have instead used modifier 55 (Postoperative management...

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