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Urgent Care and ER Billing

  1. Default Urgent Care and ER Billing
    Medical Coding Books
    We handle the Urgent Care billing for a hospital and we had a patient that went to Urgent Care for Edema. It was a new patient so we billed with a 99203. I'm assuming the patient condition became worse because they later went to the ER. My claim for the Urgent Care denied as mutually exclusive to the ER visit. Can we appeal the claim with a modifier 25 on the Urgent Care claim?

  2. Default
    It depends on the Payer

  3. #3
    Location
    Columbia, MO
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    Default
    Quote Originally Posted by vanhill View Post
    We handle the Urgent Care billing for a hospital and we had a patient that went to Urgent Care for Edema. It was a new patient so we billed with a 99203. I'm assuming the patient condition became worse because they later went to the ER. My claim for the Urgent Care denied as mutually exclusive to the ER visit. Can we appeal the claim with a modifier 25 on the Urgent Care claim?
    If you are billing for the facility then your second E&M needs a 27 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    I believe you need to consider what place of service is on the claims. Urgent care should be 20 and ER should be 23. Are the physicians in the same group?
    Dee
    CPC, CPCO, CPMA, CPCD

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