New Locum Question

Hello! Practice was using 'Dr. B' as locum. While being used as a locum Dr. B performed 24620-Q6 on a patient a day prior to Dr. 'A' returning the next day. Two days later, Dr.'A' takes the patient to the O.R. and does more extensive procedures. Which modifier is appropriate? One person states modifier '55', others say modifier '58'. Please help settle a dispute amongst coders. Thank you all very much! Marylou


  • edited May 2017
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    I cannot recommend a modifier without knowing the nature of the second
    procedure. Modifier -55 is definitely not correct as that is for post op visit
    care only. Was it a planned additional service? Was it because of
    complications/unplanned additional care? Was the first procedure just to
    minimize pain because of the dislocation nature of the service and they knew
    they were going to have to do an open procedure? Generally if the providers
    know they are going to have to perform an open procedure in the immediate
    future, a procedure is not billed at the first encounter.

  • edited May 2017
    The locum was a temporary employee and the charges were billed under your tax ID, correct? -58.

  • edited May 2017
    You really can't answer this as we don't know the circumstances surrounding the second service.

  • The second services were as follows: 24345; 34685; 24343; 64718-dos: 020316

    Original service (by Locum) was 01.31.16-24620-Q6-who stated at the time of service-postoperative plan is to obtain a CT of the elbow w/3D reconstruction for a full elucidation of the injury pattern and planning for likely additional surgery. Due to the highly unstable nature of the elbow, certainly he will require additional surgery. Considering I am going off call schedule tomorrow & Dr. blank will be resuming Orthopedic Trauma duties this patient will be signed out to Dr. blank for likely continued operative treatment of his elbow fracture dislocation.
  • edited May 2017
    This is sounding like he knew the second procedure was going to have to be done to actually treat the fracture. In that case to me he was only providing immediate relief not actual fracture care. I would not bill the initial fracture care. My guess is he treated only the dislocation. Ortho guidelines have always stated if you knew or anticipated a more extensive procedure at the time of initial treatment then you do not bill the fracture care for the initial encounter. I do not have access to my coding material right now but is there a specific code for the dislocation. If he had not provided manipulation at the initial visit I would say to bill only the EM for the first visit but I think the work was more extensive than just the EM service. From a modifier perspecitive modifier -58 would be appropriate.

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