Wiki Proper Coumadin Clinic Visit Coding

[traci.susong@gmail.com]

We are seeing patients in an outpatient hospital setting. The pharmacist sees the patient and we are billing it under the referring physician since pharmacist cannot bill. Issue is when patient see's the provider that "referred" them on the same day. We would use modifier 27 on the E/M because it looks like the patient had two office visits on the same day. Anyone else bill like this.

 

[thomas7331]

Are you talking about the coding of the professional claim or the hospital claim? If the location is outpatient hospital, 'incident to' billing is not allowed and it would be incorrect to bill a professional charge for a pharmacist's services under a physician's name. If the pharmacist is a hospital employee, you MIGHT be able to bill a clinic charge (G0463) on the hospital/UB claim is the documentation meets the definition of an evaluation and management encounter carried out under a physician's plan of care, but in that case I think it would not be correct to bill a second E&M charge with modifier 27 for the referring provider's visit because the two visits are related. I would recommend treading carefully here - I know of organizations that have run into compliance issues when try to bill E&M charges for pharmacist services. You might want to involve your hospital's compliance department in this decision.