Modifier 54 for Profee - does this change global days for claim processing?
If modifier 54 is appended to a major surgery CPT (global day 90), how would subsequent claims be processed? Specifically, would subsequent claims for the next 90 days be processed as occurring within the global day period? Or would the procedure be considered a zero day global because mod 54 was submitted indicating only intraoperative and preop services? Also, when using mod 54, would modifier 57 or 25 be used for the E/M code since we are billing only for the pre and intraop portion (assuming E/M reporting is appropriate of course). This occurs frequently in the Emergency Room
Specific example: Dislocated shoulder reduction billed with mod 54. Pt returns two months later for recurrent dislocation of same shoulder and reduced again - not sure how to code and append modifiers for second visit . Or, fracture reduction with mod 54, with subsequent visit for laceration repair and/or another fracture reduction
I have poured over the CMS Claims Processing Manual for global period claim processing and the CMS Outreach info on global day billing to find the official supporting guidance on this. Any references would be greatly appreciated.
Bridget Smith, RHIT