Wiki Billing two ER visits on the same day.

[Mohana Prasad]

Can any one help me out.

1) Scenario 1: A patient was seen at ER in the morning for Asthma and discharged while returning home got injured and presents to the same ER for injury to the leg and was seen by the same ED physician. Can the ED physician bill for two ER visits? Is the same applicable for facility coding?

2) Scenario 2: A patient was seen at ER in the morning for Asthma and discharged. The patient returned home and the asthma got exacerbated and presents to the same ER for for further evaluation and was seen by the same ED physician. Can the ED physician bill for two ER visits? Is the same applicable for facility coding?

Thank You,
N. Mohana Prasad.

 

[mitchellde]

The Er physician should combine the documentations of the 2 encounters and bill one visit. In the case of the injury as the second visit this may depend on the liability and therefore quite possible to submit 2 visits to 2 different carriers. The facility will submit 2 ED visit levels on the same day in the same revenue center and will apply a 27 modifier to the second and subsequent visit level. If a procedure is performed at either of the encounters then both visits will need a 25 modifier in addition to the 27 on the second and the claim will need a G0 condition code.
Facility billing is very different from physician!