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H&P for patient transferred for procedure

  1. Unhappy H&P for patient transferred for procedure
    Medical Coding Books
    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
    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. Default
    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
    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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