Author Topic: Which modifer to use?  (Read 1193 times)

jcfenfen

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Which modifer to use?
« on: September 22, 2010, 05:35:35 PM »
Hi,

I am billing for a primary care physician who saw the patient in the nursing home and admitted the patient in the hospital on the same day, so what should I do with the modifier?  I separate the claims for the nursing home and for the hospital, but I don't think I can bill two procedure codes on the same day(one might be rejected), or can I do that?   Thanks a lot for any input

oneround

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Re: Which modifer to use?
« Reply #1 on: September 23, 2010, 06:25:31 PM »
 In my experience to bill for an inpatient admission (99221-99223), Medicare requires that you provide initial inpatient service to the patient at the hospital and document what you provided. You cannot bill for two visits services on the same day. However, you donít have to lose reimbursement for the services. You can combine the SNF and the hospital inpatient admission and choose your level of   service based on that. In many cases, the inpatient admission has higher reimbursement than the SNF visit.
« Last Edit: September 23, 2010, 06:27:10 PM by oneround »
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

jcfenfen

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Re: Which modifer to use?
« Reply #2 on: September 24, 2010, 02:01:14 PM »
In my experience to bill for an inpatient admission (99221-99223), Medicare requires that you provide initial inpatient service to the patient at the hospital and document what you provided. You cannot bill for two visits services on the same day. However, you donít have to lose reimbursement for the services. You can combine the SNF and the hospital inpatient admission and choose your level of   service based on that. In many cases, the inpatient admission has higher reimbursement than the SNF visit.

Thank you so much for your response, it's a great help!  So I would just bill for the inpatient admission, is that right? 

Michele

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Re: Which modifer to use?
« Reply #3 on: September 24, 2010, 09:07:58 PM »
From what you have described the inpatient admission seems to trump the nursing home visit. 
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