hospitalist and psych visit same day

[bjmon83]

We have a policy that a hospitalist sees a psych patient for initial eval before going to psych ward. If the hospitalist and psych visit are charged on same day we get a denial on the psych visit. I know that no modifier is allowed in these circumstances but is there something we can do so they don't get denied? Thanks

 

[danskangel313]

The CPT guidelines state that any E/M services provided to a patient that lead to an admission are included in the admission code. If the hospitalist does the evaluation and then does the admit (he/she documents they have made the decision for the admit), you would forego coding the eval and only code for the admit. You CAN, however, use the services provided in the eval to level your admit code. If the hospitalist does the eval and another provider makes the decision for admit, the billing concept is the same except only the admitting provider can bill; the hospitalist would not be able to. On face value it seems like there's no credit or reimbursement given for the eval, but there is in the fact that you get a higher admit code.