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H & P and then Closed reduction in ER...then....

  1. Default H & P and then Closed reduction in ER...then....
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    Hello everyone,



    Our doctor did a H & P on a patient and then a closed reduction of bimalleolar (27810) in ER. Patient was not satisfied and wanted surgical managment. Dr. then admitted patient and did a history, exam, etc. as well as an ORIF (27814).

    How can this be billed?

    Dr. has 99243 as ER H & P

    First Claim ER
    99243-57
    27810

    Second Claim -In patient. I can't bill the admit code on same DOS?
    27814-58?


    Thanks, Kim, CPC

  2. Wink
    Quote Originally Posted by kibbit99 View Post
    Hello everyone,



    Our doctor did a H & P on a patient and then a closed reduction of bimalleolar (27810) in ER. Patient was not satisfied and wanted surgical managment. Dr. then admitted patient and did a history, exam, etc. as well as an ORIF (27814).

    How can this be billed?

    Dr. has 99243 as ER H & P

    First Claim ER
    99243-57
    27810

    Second Claim -In patient. I can't bill the admit code on same DOS?
    27814-58?


    Thanks, Kim, CPC

    If same Dr admitted pt and did an ORIF on same day as the consult and closed reduction you can only bill for the admission and ORIF.
    Per CPT book2009 on pg. 12 under initial hospital care: When the pt is admitted to the hospital as an inpatient in the course of an encounter in another site of service (eg, hospital emergency dept, observation status in a hospital, physicians office, nursing facility) all E & M services are provide by that physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission.

    hope that helps.

  3. Default
    It does help,

    but how would I bill the ORIF? 58 modifier as inpatient?

    Kim

  4. #4
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    Default
    since it wasnt staged to go to the OR, I would use a 78
    Mary, CPC, CANPC, COSC

  5. Default
    Quote Originally Posted by kibbit99 View Post
    It does help,

    but how would I bill the ORIF? 58 modifier as inpatient?

    Kim
    Was the ORIF right after the closed reduction? Or was there time in between?
    If pt decided right after that he/she wanted ORIF then you wouldn't bill for the closed reduction at all, since this was done on the same date of service.
    So the ORIF wouldn't get any modifier. Just the admit code would get 57 mod.

  6. Default
    ORIF was done later on that day (time lapsed).

    Thanks for all your help everyone!

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