Oncology & Hematology Coding Alert

Question: When can two different physicians (in the same practice) bill for an inpatient visit on the same day?

Maryland Subscriber

Answer: Reimbursement is made only once per day on a subsequent hospital visit per practice. A patient is considered part of both physicians within the same practice and specialty. The exception is if the second doctor was required to see the patient due to a complication, worsening condition or new problem. In this case, bill the appropriate E/M code with modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to indicate that the second visit was separate and identifiable from the first. Two different ICD-9 codes would also be needed to prove medical necessity.

For example, if a patient comes in for a follow-up visit to chemotherapy treatment, and the exam uncovers a complication that the physician is unsure of how to treat, he or she may seek the advice of another doctor in the office. This second physician then conducts an exam and advises the first physician on treatment. Both can bill an E/M service, such as 99213, and the second doctor would append modifier -25. The first physician would include the appropriate cancer diagnosis code, while the second should include the diagnosis code specific to the condition that prompted the exam.

Questions answered by Margaret Hickey, MS, MSN, RN, OCN, CORLN, an independent coding consultant in New Orleans; Dianna Hofbeck; and Lillie McCalister, CPC, president of Double-Diamond Enterprises, a coding and billing consulting firm in Conroe, Te