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Wiki H&P for patient transferred for procedure

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lynjones68

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I need help. I have a Cardiologist that is billing for the H&P on the same day as a heart catherization. The patient is transferred to our hospital from another hospital for the cath. Can they bill the H&P with modifier -25, as this is their first encounter with the patient; or is it bundled as it is clearly stated in the documentation that the patient is transferred for the procedure.:confused:
 
Bill it with a -25 on it.

It is still a consult and pretty much the reason for the cath, just make sure it is documented in the consult that the doc wants to do the cath.
 
Definition of -25 modifier

The definition of the -25 modifier is that it is used to designate a significant, separately identifiable E/M service.

By your own original question, you have identified that this "H&P" (there is NO such classification in E/M ... this is a facility requirement) is done ONLY because the patient is sent over to your facility for the cath.

I would consider this evaluation as inherent to the procedure performed the same day. HOWEVER ... not having seen the documentation, I really cannot tell you if this is truly a significant, separately identifiable E/M service. Just because the hospital requires you do an H&P on each patient you admit, doesn't mean it qualifies for the -25 modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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