Wiki need clarification for office visit/SDS please

[tdbear612@yahoo.com]

Need clarification please! Pt comes into office with an abscess. Physician decides to remove the abscess the same day, she is sent to the hospital for SDS, then is admitted after. There is no H & P for the first day, just the office note and the op note at the hospital. Would it be an office visit with mod 25, and the op note only?

 

[sivagurulingam]

My opinion :- Mod 25 applicable if the E/M service and surgery ( Minor) has done by same provider on day of the procedure.
Medicare regulation states: "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician." The same physician concept also applies when the exact same physician performs services.
Need to know other auditor comments.

 

[tdbear612@yahoo.com]

Thanks, E/M codes and admits same day seem to really confuse me.