Wiki 2 Hospital visits on same date of service


True Blue
Mims, Florida
Best answers
I am repeating my question here as I have not received a response on another thread! Any ideas?

I have a neurologist who saw a patient for a consult earlier in the day for what was diagnosed as a TIA. The patient was in Observation status - this being her second day. The patient was discharged that morning. Later that day the patient returned with further symptoms and the neurologist was called in again to do another consult. The patient was admitted as an inpatient the next day according to the hospital chart. I believe the neurologist saw her in the ED.

The billing company has contacted our biller because Medicare is denying the second visit stating you can only bill one consult per day. Now I have issues already with the way this was billed, but I am wondering what would be the correct way to capture both of these visits.

It was billed as 99220 for the first visit (which I know needs to be corrected because the neurologist was not the admitting doctor). She has billed the second visit as 99291-25 with 99292-25. I know you can bill critical care and another E/M on the same date, however I am not sure the correct way to do this - should the 25 modifier go on the other E/M code?

The other issue I see is that the second visit was a consult and I believe the ED doctor billed for critical care. I know only one physician can bill for critical care, so if this is the case and the claim denies for only one critical care visit, would it still be possible to bill for the 2 visits? If not 2 E/M codes, could I bill with a prolonged visit code - and if so, what documentation would there have to be in order to bill a prolonged code?

Hopefully someone can answer this for me - and hopefully this makes sense! :eek:

Just so I have this clear, the patient was in observation for Days 1 and 2; on Day 2, the patient was seen by the neurologist for a consult and then discharged. Also on Day 2, the patient returned to the ED(?) and was seen again by the neurologist for a consult. Then on Day 3 the patient was admitted to inpatient?

Was the discharge billed? Was the patient admitted via the ED? And, at what point did the critical care come into play? I'm a bit lost on that one.

It is correct that only one consult can be paid, but MC doesn't recognize consultation codes, so they should be going out as subsequent care codes. Is anyone appending mod AI to anything?