Author Topic: Office visit and Hospital visit on the same day  (Read 1870 times)

CALI

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Office visit and Hospital visit on the same day
« on: January 09, 2012, 03:14:17 PM »
Hi All,

A patient had an office visit with one of our doctors with hbp earlier in the day.  Later in the day the patient had severe abdominal pains and was admitted to the hospital. The diagnosis was different for each visit.

The same doctor visited him at the hospital on the same day. What modifier would I use to get a payment for both doctor's visits?

Thanks to everyone for helping me with this.
CALI

Michele

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Re: Office visit and Hospital visit on the same day
« Reply #1 on: January 11, 2012, 06:50:49 AM »
I do not believe there is a modifier to indicate this.  Possibly the 25 modifier.  I would try billing them showing the different dx's for each service and if denied, file an appeal.

But remember, it may not matter, the insurance plan may not allow for an office visit and hospital admission on the same date, regardless of whether they were for different issues.
 
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sierratam

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Re: Office visit and Hospital visit on the same day
« Reply #2 on: January 29, 2012, 06:48:57 PM »
Just to clarify because this happens often enough to me... in your scenario you cannot bill for the office visit when the provider sees that patient that same day in the hospital, you must write off the office visit, but do bill for the hospital visit. Defininately no modifiers will help. This rule can be found in your CPT book in the guidelines of the hospital visits.