pvang
Networker
Hi -
I have a question…patient went to see his/her PCP about a broken arm and they spoke with an Ortho doctor that would be meeting patient at the Hospital for surgery. Patient was told to go to the ER. Patient arrives at the ER and in the triage the PA evaluated the patient before surgery. (Side note: Patient thought that she was just getting sent straight into surgery). Ok so patient was charged for the PCP E/M visit, an E/R E/M visit from the PA , and the Facility charge for E/M visit in the ER, and the Ortho surgeon for the procedure done. Patient is disputing claims and saying that she wasn't treated in the ER that day so she shouldn't get any "E/M" charges from the PA or the facility.
Ok so here comes my questions:
Is the billing for this DOS correct (aside from patient being confused of where she was)?
Shouldn't the E/M in the ER be the E/M visit that patient ultimately decides for surgery so modifier 57 should be appended?
If patient decided had surgery after being seen in the E/R, shouldn't the facility charges only be for the operating room and not the E/M visit?
Any help advice would be great! Thanks in advance!
Pa Tang Vang, RHIT
I have a question…patient went to see his/her PCP about a broken arm and they spoke with an Ortho doctor that would be meeting patient at the Hospital for surgery. Patient was told to go to the ER. Patient arrives at the ER and in the triage the PA evaluated the patient before surgery. (Side note: Patient thought that she was just getting sent straight into surgery). Ok so patient was charged for the PCP E/M visit, an E/R E/M visit from the PA , and the Facility charge for E/M visit in the ER, and the Ortho surgeon for the procedure done. Patient is disputing claims and saying that she wasn't treated in the ER that day so she shouldn't get any "E/M" charges from the PA or the facility.
Ok so here comes my questions:
Is the billing for this DOS correct (aside from patient being confused of where she was)?
Shouldn't the E/M in the ER be the E/M visit that patient ultimately decides for surgery so modifier 57 should be appended?
If patient decided had surgery after being seen in the E/R, shouldn't the facility charges only be for the operating room and not the E/M visit?
Any help advice would be great! Thanks in advance!
Pa Tang Vang, RHIT