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E/M with modifier

  1. #1
    Location
    Kachina Coders
    Posts
    53
    Default E/M with modifier
    Medical Coding Books
    i code for a group of hospitialist. The patient was seen on the 17th for the e/m service on the same day there was a procdedure done by another doc in the same group which modifier would you use?
    Last edited by Cynthia A; 10-12-2009 at 09:56 AM.
    Cynthia
    Mesa, AZ
    CPC

  2. #2
    Default
    Same specialty?

    If they are different specialties no modifier is required or appropriate.

    Laura, CPC, CEMC

  3. #3
    Location
    Kachina Coders
    Posts
    53
    Default
    Yes they are in the same group
    Cynthia
    Mesa, AZ
    CPC

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    If they are in the same specialty and you are billing on one 1500 then yes, if they are two different specialties and you are billing 2 1500s then no.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default
    So one hospitialist sees the patient then later in the day another hospitialist comes in and does what procedure?

    Laura, CPC, CEMC

  6. #6
    Location
    Kachina Coders
    Posts
    53
    Default
    I do not do the billing.

    I am asking how you would code this visit

    I have the 2 docs in the same group.

    Doc A saw the patient in the morning

    Doc B did a procdure

    How would you code showing Doc B ?
    Cynthia
    Mesa, AZ
    CPC

  7. #7
    Default
    There is a difference between being in the same group and being of the same specialty.

    I have multiple specialists that belong to the same group. I can have a hospitalist see a patient in the AM then and CVT surgeon do a procedure the PM and there is no modifier required on the hospitalists visit. They are not seen as the same provider because they are different specialties.

    I don't have any hospitalists that do procedures so I am not sure what you are dealing with. Not trying to be difficult, just trying to answer the right question.

    Laura, CPC, CEMC

  8. #8
    Location
    Kachina Coders
    Posts
    53
    Default
    It is my understanding the our hospitalist group is under the same ID so i would say they are the same speciality.
    Cynthia
    Mesa, AZ
    CPC

  9. #9
    Default
    If the decision for surgery was made at that visit you would use either the 25 or 57 modifiers depending on the procedure. If the visit had nothing to do with the procedure at all then you would use a 24.

    If the decision for surgery was made prior to this visit, this visit is most likely included in the global and not billable.

    Having said all that I think this is probably incorrect because odds are they are not the same specialty and their billing would not affect each other.

    I strongly suggest you find out what specialties they actually are. Even though you may not be the one filling out the claim form you can not properly code without knowing what you are dealing with specialty wise.

    Just my opinion,

    Laura, CPC, CEMC

  10. #10
    Location
    Kachina Coders
    Posts
    53
    Default
    I am sorry for all the confusion as it is starting with me. We code out patient but for inpatient so our coding is a bit different. We do not do a surgical global period for a central line. All of our Doc are under one ID number so therefore they are all in one. Same group same speciality.
    Cynthia
    Mesa, AZ
    CPC

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