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Help Please

  1. #1
    Default Help Please
    Medical Coding Books
    I have a physician working NS that had to be recalled to attend to 2 patients that were admitted yesterday by another physician. He informed me this morning to let me know the circumstances of both cases. He is not sure how to bill (what modifier to use) as he did have to re-examine both patients, have additional tests performed, review their cases, etc.

    Modifiers 24 & 25 are for the same physicians seeing the patient multiple times, does this include the group of physicians? Which modifier could I use? Would the modifier go on both charges?

  2. #2
    Location
    Columbia, MO
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    12,531
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    I am not entirely certain I understand. Tell me if this is correct. You have multiple physicians in your group, and one of them admitted 2 patients and now your physician has seen both patients again. So are both physicians in the same specialty? were both visits to each patient on the same day as the admission?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Help
    Quote Originally Posted by mitchellde View Post
    I am not entirely certain I understand. Tell me if this is correct. You have multiple physicians in your group, and one of them admitted 2 patients and now your physician has seen both patients again. So are both physicians in the same specialty? were both visits to each patient on the same day as the admission?
    Hi Debra -

    Our physician (Dr. S) admitted 2 patients on Dec. 28th; Another physician (Dr. B.) was recalled to visit the same two patients late in the evening due to additional problems; issues and complaints. I know I cannot bill twice on the same DOS, but the patients were admitted by one physician then another physician (our service) had to go back and re-examine, re-test, etc -- the same two patients for other problems on the same DOS.

    This is due to the circumstances for each of the patients. How would I bill this?

    Thanks

  4. #4
    Location
    Phoenix, AZ
    Posts
    620
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    IMO, if they are the same specialty, then add all the documentation together and bill one appropriate E/M. If they happened to document the time, you can add prolonged services.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  5. #5
    Location
    Columbia, MO
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    I am in agree with this, add it all up and bill one code I will add you MIGHT be able to append prolonged time but only if total time spent is documented. And since it is inpatient then floor time will count as well.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    Quote Originally Posted by mitchellde View Post
    I am in agree with this, add it all up and bill one code I will add you MIGHT be able to append prolonged time but only if total time spent is documented. And since it is inpatient then floor time will count as well.
    Thank you so much! This was a bit confusing.

    Have a Happy New Year!

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