This article includes:

• Surgical modifiers with definitions
• Guidelines for billing multiple surgical procedures
• Modifiers in the post-op period
• Avoiding CPT® modifier mishaps
• Citations

Members can also download the Global Surgery Coding Guide. Some of the information in this article and in the billing guide is the same.

Billing for Surgical Services

Before submitting a claim that has more than one line item for surgical services, a coder needs information. Most surgical practices subscribe to a program that makes looking up global days and bundling edits relatively easy.

• Check the Medicare Fee Schedule Database for the global days for each surgical service.
• Check the NCCI edits for bundling.
• Payment for a surgical procedure includes certain pre-operative, intra operative, and post-operative care.

Related Issues: Surgical Modifiers in the Global Package

CMS instructions on the global surgical package, including the use of modifiers can be found here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

Publication 100-04, Chapter 12, Section 40

Look in the CPT^® book for complete descriptions of all modifiers, including modifiers 54 & 55.