Wiki Office visit and Hospital Visit in the same day....................


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Ok here is the scenerio. A patient (Medicare pt) came in and was seen for a routine follow up. She had no new problems. Then later that same evening she was admitted to the hospital (by one of out other doctors) for chest pain. Can I bill for an offcie visit and a hospital admit on the same day? Is there a modifier that I can use? Thank you for any help.
Both providers were of the same specialty?

If different specialties are involved there shouldn't be a problem, no modifier either.

If they are the same specialty you would need to combine the documentation of both notes and level the admit based on that.

Both docs are in our group. One doc saw pt in our office and one doc admitted same pt-same day to the hospital for a completely different reasons.
See Medicare exception to this rule below - I know you have an outpatient visit and then an admit later in the day but because it was to evaluate a problem that was not addressed and could not have been addressed during the first visit I think this exception would apply and you could bill out both the first visit (E/M or preventive) and the admit - may have to appeal and site this from the Medicare Carrier's Manuel.

Christie Musser, CPC

Paragraph B of Chapter 12, Section 30.6.7, clarifies “physician in a group practice” for office/outpatient E/M Visits provided on the same day for unrelated problems as follows:
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).