Wiki Echo Interp & Hosp Visit on Same Day

[bmcquilling]

Can anyone tell me what is appropriate way to bill a hospital visit (99232) and an echo interpretation only (93306-26) that were done on the same day by the same physician? The hospital visit (99232) has not been paid, and I am being told the hospital visit is an integral part of the echo interpretation, therefore, no reimbursement is being made for the hospital visit.

 

[Cyndi113]

Did you add a -25 modifier to your 99232?

 

[theresa.dix@tennova.com]

You would need to add modifier 25 to the 99232.

 

[jessica1974]

You cannot bill for a sub hosp visit & an echo on the same day. It will be denied by the carrier. You either have to bill for one or the other. I have found this out by trial and error. Every time we bill both the hosp visit gets denied. I def wouldn't use a mod 25 because if you tag one on to every time they do that you could come up for audit as over usage on that modifer. Hope this helps

 

[littlebitt00]

A modifier 25 should be appended on the E/M service to indicate separate. I hope this is helpful to you.

 

[jlb102780]

I add mod 25 on mine and they pay just fine

 

[GBielskis]

Subseq day/echo same day

We bill that combination all the time and get paid for both without a 25 modifier. The echo is a diagnostic procedure with no global. You might want to look if the subsequent day is within global of another procedure. If it is for a different diagnosis or reason, then a 24 modifier would be attached to the subsequent day.

 

[davecripps]

This is recent (6 months or so) problem for our practice & like device checks with an E&M visit only with commercial insurances. I believe it to be appropriate to add a 25 because the E&M services are done separately from the interp. But I wondering what changed and when and where to find documentation of this because it seems kind of outrageous from a provider standpoint? I'm going to search the payers websites but does anyway has any additional information I can use to at least support us adding the 25 modifier initially to the E&M visit rather than once the claim is denied? Thank you

 

[Jess1125]

We bill that combination all the time and get paid for both without a 25 modifier. The echo is a diagnostic procedure with no global. You might want to look if the subsequent day is within global of another procedure. If it is for a different diagnosis or reason, then a 24 modifier would be attached to the subsequent day.

I agree. We bill both without a -25 all the time and get paid for both. I agree, echo's don't have a global period so you shouldn't have to put a -25 on. Global concept doesn't apply.

Jessica CPC, CCC