# Billing 2 hospital visits same day



## tlwhlw (Mar 8, 2012)

Physician saw patient in the morning as an admission to the hospital, documented as 99223.  Later in the afternoon, the patients  condition worsened, had a TIA, was in ICU. Physician made another visit that same day and documented 99291 of 35 minutes.

I coded as this:
12/31/11  99223, 728.87, 414.00, 250.00, 747.22
12/31/11  99291-24, 435.9, 782.0, 599.0, 747.20

Medicare paid the 99291, but denied the 99223 as only one visit allowed per day.  Any thoughts???


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## mhstrauss (Mar 9, 2012)

tlwhlw said:


> Physician saw patient in the morning as an admission to the hospital, documented as 99223.  Later in the afternoon, the patients  condition worsened, had a TIA, was in ICU. Physician made another visit that same day and documented 99291 of 35 minutes.
> 
> I coded as this:
> 12/31/11  99223, 728.87, 414.00, 250.00, 747.22
> ...



My thoughts are that the modifier 24 should be changed to 25.  Also, we have a ton of trouble getting Medicare (we have Pinnacle) to pay both an inpatient E/M and critical care, even with correct modifiers and appropriate documentation.
However, the modifier change is a start, and just be prepared to submit supporting documentation!


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