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Same DOS, Different POS

deyoung

Guru
Messages
137
Location
Glendale, AZ
Best answers
0
Dr sees patient on the day of discharge at the hospital. Patient presents to the outpatient clinic for follow-up on the same day as discharge. Dr is asking if he can bill a 90862 (med mgmt) for the clinic visit in addition to the 99238 (discharge) since they are 2 different places of service.

My thinking - med mgmt is included in the discharge, why would it need to be done again on the same day at the clinic. Maybe an est. patient E/M for follow-up visit if he is seeing patient to discuss outpatient careplan?

Patient will most likely continued to be seen at the clinic for med mgmt. If the patient had come in and was seen by a different Dr a 90801 would have been billed but the question comes in because it's the same Dr that also saw patient for discharge.

Please share with me your thoughts. Thanks!
 

1073358

Expert
Messages
454
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0
I question the medical necessity of 2 visits.

I dont think I would bill it.
 

ARCPC9491

True Blue
Messages
700
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0
I don't think I'd bill it either. The care plan should have been discussed/reviewed at discharge. What's the purpose of coming in the same day of discharge? Has anything changed in such a short amount of time that requires he be seen? I guess you could appeal it but I don't think based on what you have provided it would meet medical necessity as mentioned above.
 

deyoung

Guru
Messages
137
Location
Glendale, AZ
Best answers
0
Thanks for the replies. I agree with you both...not sure why patient would need to be seen again in such a short amount of time unless it was with a new physician who had to familiarize himself with the patient and set-up a careplan for outpatient services. Thanks!
 

kevbshields

Guest
Messages
1,101
Location
Louisville, KY
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0
90862 is bundled into 99238 per CCI edits. An appeal will be pretty useless with that factor in favor of only coding one service.

You're provider's out of luck. 99238 would be most appropriate.
 
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