Modifiers

We have a pt that had sx elsewhere by another physician.
we are treating her for post op but not global. What is the appropriate modifier to use? We billed out modifier 55 and that was rejected.

re: MODIFIERS

The surgeon, other surgeon, would have had to of used a modifier -54 (surgical care only). If not, then he/she has already been paid for the postoperative care so you will have to appeal. Call the carrier and make sure of the correct appeals process for this and don't forget the appeals address, it may differ from the claims mailing address.
This is when the surgery was performed by another physician and your physician, not the surgical physican, is treating the patient for postoperative care within the global period of the procedure performed by that other physician.