OV then decision to send to ER what E/M?

karenoliver

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Glendale Arizona
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I code for an orthopeadic clinic where we have an outpatient office and work throughout local hospitals as truama surgeons, when we have a new pt visit in our clinic (99202) and we make the decision that sx needs to be performed emergently and we send them to one of the local hospitals and the doc will meet them there or set them up with one of the other partners in our practice do we bill for the office visit or do we bill for the H&P in the hospital,and does anyone know where I can find the guidelines for this?? thanks in advance!

Karen
 
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Milwaukee WI
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Same practice?

If the surgeon who will be performing the surgery is ALSO in your practice/specialty, then you will code ONLY the hospital admission, with decision for surgery. You roll all the work documented (including the office note and any ER note if done by your surgeons) into one level of service. You should have a policy/protocol in your practice that determines WHO gets credit for this E/M. Since it will be either an Initial Inpatient or Initial Observation code, I would say the surgeon who is on call at the hospital should probably get the credit, but if the clinic doctor is actually going to go to the hospital to meet the patient there, and will perform the H&P, then that doctor can get the credit. Just be sure you have a protocol in place and you follow it strictly. (And since this sounds like a decision for surgery, don't forget your modifier ... either -57 for major surgery, or -25 for minor)

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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Central Pittsburgh
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I agree. And to further that, if the initial visit is not performed because all information was done in the office or there was no time, then the office service with the -57 modifier can be billed. (Of course, check your payer to confirm they pay for both in and out services on the same day, etc.)

Suzan Berman CPC, CEMC, CEDC
 
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