Wiki Observation And Er Coding Question

[CHRISTIE THOMAS]

Can anyone help with the following coding question? I had a patient that was admitted to observation on 5-7-08 (99218) and dismissed on 5-8-08 (99217). The same patient returned to the ER later that same day and the same doctor saw him in the ER. I am charging the PC for this and do not know if there is anything else I can charge for the additional ER work done. The patient was assessed and given new medication at the ER visit.

Thank you in advance
Christie Thomas-CPC,PCS

 

[Erica1217]

I would bill the ER visit w/ a modifier -25 and appeal when denied.

Medicare Claims Processing Manual, page 39 -40
http://cms.hhs.gov/manuals/downloads/clm104c12.pdf


"As for all other E/M services except where specifically noted, carriers may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident)."


Erica

 

[Sugumaran]

we use to bill this second ER visits with 25 modifier if the patient was covered by commercial insurance but if the patient was covered by medicare insurance means we use to bill only the higher observation EM and no charge the second visit
thanks

 

[CHRISTIE THOMAS]

Thanks for all of your input. I'll try 25 mod and see what happens.

Christie