Same day visits

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Muncie, IN
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We had a patient seen in the office for a preventative visit and everything was fine at this time. Later in the day, parents called stating something was wrong with the child. Pt came back in at this time, the child was admitted to the hospital for a completely different service. How can we be sure the preventative gets paid?
 
Messages
373
Best answers
0
We had a patient seen in the office for a preventative visit and everything was fine at this time. Later in the day, parents called stating something was wrong with the child. Pt came back in at this time, the child was admitted to the hospital for a completely different service. How can we be sure the preventative gets paid?

You will need to append modifier 25 to the second E/M service (office or hospital if managed by your physician) and it may be helpful to contact the payer to learn whether the automated payment system edits will result in denial of one of the services and if so, what you can do to trigger a manual review of the claim (e.g., narrative on claim stating separate encounters, submission of encounter note via electronic attachment or fax). If the payer denies, an appeal with sufficient medical record documentation would be necessary. I am afraid there are no guarantees as each plan may adopt differing policies and procedures.
 
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