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Thread: Mod for hospital visit

  1. #1
    Join Date
    Apr 2007
    Prescott, AZ

    Cool Mod for hospital visit

    AAPC: Back to School
    I have billed out hospital charges for a patient seen on the same day but two seperate hospitals.

    hospital #1 -- 99291 w/resp failure, documented time of 70 minutes

    Hospital #2 -- 99223, patient was ICU, but physician chose to code as 99223.

    Medicare has denied pmt for 99223, as can't bill this code same day as a 99291. After calling Medicare to explain that charges were for 2 seperate hospitals, they suggested a modifier may possibly be used. It's not bundled, so a Mod 59 will not work. Any suggestions???
    Tracy L. Wood, CPC

  2. #2
    Join Date
    Apr 2007


    I've always used a modifer 25 on my hospital visits if I am billing critical care as well.
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  3. #3


    please let me know whether the physician is the same?

  4. #4
    Join Date
    Apr 2007
    Prescott, AZ


    Yes, same physician, same patient, two different hospitals
    Tracy L. Wood, CPC

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