Two hospital visits same date

jdibble

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I have a neurologist who saw a patient for a consult earlier in the day for what was diagnosed as a TIA. The patient was in Observation status - this being her second day. The patient was discharged that morning. Later that day the patient returned with further symptoms and the neurologist was called in again to do another consult. The patient was admitted as an inpatient the next day according to the hospital chart. I believe the neurologist saw her in the ED.

The billing company has contacted our biller because Medicare is denying the second visit stating you can only bill one consult per day. Now I have issues already with the way this was billed, but I am wondering what would be the correct way to capture both of these visits.

It was billed as 99220 for the first visit (which I know needs to be corrected because the neurologist was not the admitting doctor). She has billed the second visit as 99291-25 with 99292-25. I know you can bill critical care and another E/M on the same date, however I am not sure the correct way to do this - should the 25 modifier go on the other E/M code?

The other issue I see is that the second visit was a consult and I believe the ED doctor billed for critical care. I know only one physician can bill for critical care, so if this is the case and the claim denies for only one critical care visit, would it still be possible to bill for the 2 visits? If not 2 E/M codes, could I bill with a prolonged visit code - and if so, what documentation would there have to be in order to bill a prolonged code?

Hopefully someone can answer this for me - and hopefully this makes sense! :eek:

Thanks,
 
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