Wiki Office visit sent to ER

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Hello, this is my first time using the forum, so I wasn't sure how to make a post/thread. Hopefully someone can help me out or point me in the right direction. I bill for an Internal Med office and the doc says there is a modifier to use when a patient is seen in the office and then later transported to the hospital. I have one now that was seen for new pt visit but half way through, the ambulance was called and transported the pt to hospital. The doc wants me to bill 99204-AI-25 with 99354, can anyone provide any insight, please?
 
Was your provider the admitting physician at the hospital? The use of the AI modifier is for when a patient is seen at a facility and a distinction is needed for the primary physician of records. It would not normally apply to a regular office visit of 99204
 
Chelle-Lynn said:
Was your provider the admitting physician at the hospital? The use of the AI modifier is for when a patient is seen at a facility and a distinction is needed for the primary physician of records. It would not normally apply to a regular office visit of 99204
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Yes that's what I was thinking, the AI modifier is for the admitting physician. No my provider was not the admitting, the patient was there for an OV and became severely hypoxic and the ambulance was called. Is there a modifier signifying the transport from the office to the hospital, or do I just bill the E/M? Also thanks for your input/response!!!!
 
You would just bill the OV. The Ambulance provider would code their claim with a QM and/or other destination modifiers.



Heather Jones, CPC, CPB
Absolute Practice Solutions
(ph) 336-422-7824
(f) 877-217-6073
 
Agreed; I also bill for an Internal Medicine practice and have had this happen many times. You would be only for the E/M code; just the office visit, no modifier.
 
hello guy, first time asking for help ---
i have a patient presenting with pain and dr is send pt to er for to schedule surgery same day as office visit as my dr as the performing surgeon -- how do i code this we are a gyn office -- usually i code 99215,57 but is there a better code to use ??? then i was going to do claim for outpt surgery-
thank for any help
 
Regarding the level of visit, it is coded based on 2 of 3 elements from problem, data, and risk. There is clearly not enough information here to determine whether or not 99215 is appropriate. Modifier -57 is used to override the global surgical package when the visit was for the decision to perform surgery. That certainly seems like the case here.
If the provider only briefly evaluated the patient in office, sent to the hospital, and then performed another visit at the hospital and that is when the actual decision for surgery was made, you should bill for the hospital visit with -57 instead of the office visit.
 
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