Wiki Boss wants an Answer

[strwberry239]

My boss approached me today questioning why we can not bill 2 E/M codes in the same if:
A patient comes in to see a provider in the morning for a f/u on her gallbladder and then later in the day she is seen again by the same provider urgerntly for a laceration to the hand; a cut from a kitchen knife.
My boss is particularly looking at the Modifier 25 to attach to one of the 2 E/M codes since the OV's are seperately identifable services. I couldnt give her the answer she was looking for/a concrete answer. HELP Please!!

 

[pamtienter]

You can bill for both of these visits since they are unrelated. The information is in CMS' Medicare Claims Processing Manual, 100-04, under Chapter 12 for Physician services, section 30.6.7 Payment for Office or Other Outpatient Evaluation and Management. Section B.
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

You would need the 25 modifier on the second E/M and it may be denied but you could appeal with documentation.

 

[FTessaBartels]

Is the first visit postop?

I'm not sure I correctly understand the original post ... but if the first visit is follow-up for gallbladder removal it may be in the postoperative period and should be coded as 99024. The hand laceration visit would then be coded as per documentation with a -24 modifier (unrelated to global period).

If there is no post-op global period, then I agree with Pam.

F Tessa Bartels, CPC, CEMC

 

[strwberry239]

OK. I think I should specify as to what type of office visit issue we are having... Ex: can we code a 99214 twice in one day, or 99212 and 99214 for the same patient on the same DOS. In reference to the initial post.
If this is not allowed, why not?
I understand we bill a critical care service w/ an outpatient OV (this I knew).