Billing 2 hospital visits same day

tlwhlw

Networker
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71
Location
Phoenix, AZ
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Physician saw patient in the morning as an admission to the hospital, documented as 99223. Later in the afternoon, the patients condition worsened, had a TIA, was in ICU. Physician made another visit that same day and documented 99291 of 35 minutes.

I coded as this:
12/31/11 99223, 728.87, 414.00, 250.00, 747.22
12/31/11 99291-24, 435.9, 782.0, 599.0, 747.20

Medicare paid the 99291, but denied the 99223 as only one visit allowed per day. Any thoughts???
 

mhstrauss

True Blue
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Baton Rouge
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Physician saw patient in the morning as an admission to the hospital, documented as 99223. Later in the afternoon, the patients condition worsened, had a TIA, was in ICU. Physician made another visit that same day and documented 99291 of 35 minutes.

I coded as this:
12/31/11 99223, 728.87, 414.00, 250.00, 747.22
12/31/11 99291-24, 435.9, 782.0, 599.0, 747.20

Medicare paid the 99291, but denied the 99223 as only one visit allowed per day. Any thoughts???
My thoughts are that the modifier 24 should be changed to 25. Also, we have a ton of trouble getting Medicare (we have Pinnacle) to pay both an inpatient E/M and critical care, even with correct modifiers and appropriate documentation.
However, the modifier change is a start, and just be prepared to submit supporting documentation! :)
 
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