Oncology & Hematology Coding Alert

Question: Under what circumstances can two  physicians in the same practice bill for an inpatient visit on the same day?

Maryland Subscriber
 
 Answer: Reimbursement is made once per day on a subsequent hospital visit per practice. A patient is considered part of 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. Also, list two different ICD-9 codes 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. An exam is conducted and the doctor 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 includes the appropriate cancer diagnosis code, while the second includes the diagnosis specific to the condition that prompted the exam.