Question ER to Observation pro fee coding

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Scott City, KS
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When a patient is admitted to Observation directly from the Emergency Room, we normally have not ever billed two professional fees; one for ER and one for the first observation day. Recently one of our coders stated that if 25 and the modifier XU are used, we could bill for both? I don't necessarily agree because it is for the same diagnosis, same day, pretty much same time period because it is an admission directly from the ER and to me 25 and XU would be for something different or different provider. This would even be for the same provider.
How would the rest of you charge the pro fees? Both or just for the OPO first day? Thank you!!
Vicki
 
Messages
7
Location
Scott City, KS
Best answers
0
When a patient is admitted to Observation directly from the Emergency Room, we normally have not ever billed two professional fees; one for ER and one for the first observation day. Recently one of our coders stated that if 25 and the modifier XU are used, we could bill for both? I don't necessarily agree because it is for the same diagnosis, same day, pretty much same time period because it is an admission directly from the ER and to me 25 and XU would be for something different or different provider. This would even be for the same provider.
How would the rest of you charge the pro fees? Both or just for the OPO first day? Thank you!!
Vicki
 

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thomas7331

True Blue
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You cannot bill two different E/M services for the same provider on the same date of service - it's one or the other, and billing a modifier 59 or XU is not really appropriate in this situation (and is unlikely to work anyway). Some payers may allow a second E/M on the same date if the patient leaves and then returns at a later time for an unrelated problem, but in my experience, even in this situation it is very difficult to get payment for a second E/M on the same day. In the situation you describe above, you can only bill either the emergency room E/M code or the initial observation E/M code on the initial day for a given provider and specialty, but not both.

The situation is different if the emergency physician admits the patient to the care of a hospitalist or other specialist. In that case, the ER physician will bill the ER code and the hospitalist or specialist will bill the initial and any subsequent observation service codes.
 
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