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Thread: H&P for patient transferred for procedure

  1. #1

    Unhappy H&P for patient transferred for procedure

    AAPC: Back to School
    I need help. I have a Cardiologist that is billing for the H&P on the same day as a heart catherization. The patient is transferred to our hospital from another hospital for the cath. Can they bill the H&P with modifier -25, as this is their first encounter with the patient; or is it bundled as it is clearly stated in the documentation that the patient is transferred for the procedure.

  2. #2
    Join Date
    Apr 2007


    Bill it with a -25 on it.

    It is still a consult and pretty much the reason for the cath, just make sure it is documented in the consult that the doc wants to do the cath.

  3. #3


    Thank you. It seems that no one has answers to this. As the main Cardiology hospital in the area, we get about 3-4 of these a day.

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Definition of -25 modifier

    The definition of the -25 modifier is that it is used to designate a significant, separately identifiable E/M service.

    By your own original question, you have identified that this "H&P" (there is NO such classification in E/M ... this is a facility requirement) is done ONLY because the patient is sent over to your facility for the cath.

    I would consider this evaluation as inherent to the procedure performed the same day. HOWEVER ... not having seen the documentation, I really cannot tell you if this is truly a significant, separately identifiable E/M service. Just because the hospital requires you do an H&P on each patient you admit, doesn't mean it qualifies for the -25 modifier.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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