Wiki Admission E&M & Procedure same day

[Hopp]

Just wondering how to code for an admission and procedure on the same day?
Example: 99223 25? or 57? or both and Hernia repair I think thats a 49505 don't have my CPT book with me. I tried just using the 57 on the 99223 but did not get paid for the admission code. Also, is there a manual for CCI edits? Thanks for any help. Cricket/Hopp

 

[mjewett]

Modifer 57 would be correct, not 25, but most carriers won't pay for the E/M if it was performed within two days of the surgery. If the E/M was two days or more prior to the surgery and at the time of the E/M the doctor decided the pt. would require surgery. Then you would bill E/M mod 57.

Hope this helps.
Melissa

 

[acbarnes]

I agree Mod 57 is correct. If the decision for surgery was made during admit e/m, then you can appeal for payment. If decision was made prior to admit, then you cannot use 57. It would then be inclusive.

NCCI Edits can be found at CMS website.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp#TopOfPage