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Thread: 2 E.D. visits same day 99283/99284

  1. #11

    Default Vicente Velasco, CPC-P

    Unlimited Exam Attempt
    As a payer here in Abu Dhabi, UAE we do collect deductible for all types of Consultation whether it is emergency or not.
    My question is, if the provider billed two Emergency E&M wherein from the first E&M we already collected the deductible and since there is no follow up for emergency, is it right to collect another deductible for the second emergency visit?
    Please note that the patient is complaining for the same problem, visited on the same day with four hours gap.
    Does it matter if the patient was seen by a different emergency doctor?

    Thank you very much!

  2. #12
    Join Date
    Apr 2007
    Posts
    2,473

    Default

    That would depend on the patients medical plan benefits.
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
    Fee Schedule Configuration Specialist - Remote

    15 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  3. #13

    Question E/M Question.. Can anyone explain correct answer

    The patient is a 35-year-old male who presents to the emergency department (ED) after several hours of low back pain, nausea, and chills. The ED physician takes a detailed history and performs a comprehensive examination. A urinalysis lab and CT of the abdomen is ordered. The results of the CT show two small kidney stones. The ED physician discusses the results with the patient and tells him the stones are small and will pass on their own. Medical decision making (MDM) of moderate complexity is made with the patient being discharged, with a prescription of pain medication, and with a diagnosis of kidney stones. Select the E/M code and diagnosis code(s).
    1) 99283, N20.0
    2) 99284, N20.0

    Can anyone help me to get correct answer for this question with explanation?

  4. #14

    Default

    We combine visits also unless the patient presents with a different problem. Then we bill both visits.

  5. #15

    Default different e/m's

    I believe as long as its two diff dx, the modifier 24 can be used,,,, depending if unrelated procedures were done you may have to use mod 79,,,,, if it comes down to the same physician, same dos, same dx, with procedures, use mod 78, without procedures, modifier 25 is the one that fits best,,, hope this helps

  6. #16
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,212

    Default

    Quote Originally Posted by alt9017@nyp.org View Post
    I believe as long as its two diff dx, the modifier 24 can be used,,,, depending if unrelated procedures were done you may have to use mod 79,,,,, if it comes down to the same physician, same dos, same dx, with procedures, use mod 78, without procedures, modifier 25 is the one that fits best,,, hope this helps
    Modifier 24 is used when the surgeon is seeing a patient in the post operative time for an unrelated diagnosis. 78 and 79 modifiers can never be used on E&M codes they are only for procedure codes. If the payer will allow the physician to bill for two encounters on the same day, and most will not, then you would use the 25. Facility billing is completely different . A patient may return multiple times to the facility, ER or clinic and see the same provider. And while the provider may bill only one E&M, the facility may submit multiple E&Ms on the same claim and I se the 27 modifier on the second and subsequent. It does not matter for the facility if it was the same dx or different.

    Debra A. Mitchell, MSPH, CPC-H

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