Wiki 25 modifier

[abhiramtc]

patient admitted in inpatient hospital with abdominal pain but on the same day patient went to critical care with different provider with different diagnosis.
Can we bill 99223 for one provider & 99291 for another provider with 25 modifier.
ANY EXPERT PLEASE REPLY THIS THREAD.
PLEASE RESPONSE
THANKS IN ADVANCE...

 

[kdlberg]

This is what Medicare has to say: "in situations where a patient receives another E/M visit on the same calendar date as critical care services, both may be billed (regardless of practitioner specialty or group affiliation) as long as the medical record documentation supports: 1) that the other E/M visit was provided prior to the critical care services at a time when the patient did not require critical care, 2) that the services were medically necessary, and 3) that the services were separate and distinct, with no duplicative elements from the critical care services provided later in the day. Practitioners must use modifier -25 (same-day significant, separately identifiable evaluation and management service) on the claim when reporting these critical care services."

So if the patient was admitted and the first provider did the initial visit, then another problem developed which required critical care, both can be billed. Although I would pay attention to #3 here: "with no duplicative elements." However, if they were for two separate problems, in two different organ systems, there's probably not going to be a lot of overlap.

The full document is here: https://www.cms.gov/files/document/r11288CP.pdf