Wiki ER E/M same day admission E/M

[JENSULLIVAN]

We have had multiple denials with ER E/M(physician not facilty code)-99285, same day admission by our hosptialist, 99222. Different specialities, different place of service, but in our case, we own the ER, so we have same Tax ID number. Can we bill and be paid for both E/M, same day as admission to hospital? NCCI edits says "NO", Medicare policy manual says we can bill ad be paid for both. Please someone help and tell me what I'm missing or should we be charging only one E/M. Modifer 25 is on ER E/M, AI on hsoptialist E/M.

Thanks, Jennifer

 

[shruthi]

ER and E&M cannot be billed on same day.
If patient initially came for ER and later admitted to hospital as inpatient then we need to bill only inpatient admission code.

Regards,
Shruthi.

 

[sswisher]

We have a single tax ID and successfully bill both ED pro fees and hospitalist pro fees for the same patient on the same day. Are claims submitted with the correct provider taxonomy? If the taxonomy is inaccurate on the claim, physicians might be lumped together rather than separate specialties, leading to rejection. Sounds unlikely, but I've seen it happen. http://codapedia.com/article_475_NUCC-Taxonomy-Codes-Vs-Medicares-2-Digit-Specialty-Codes.cfm http://www.cms.gov/Medicare/Provide...ation/MedicareProviderSupEnroll/Taxonomy.html