Wiki ER Same DOS and different diagnosis

[08pancho]

i code for facility and professional. The patient came in in the morning and at night for totally different diagnosis. Should i join everything to make a higher E/M or should they be billed separate with modifier 27? I am not able to find current information. Please help

 

[mckaya]

Are you billing for Medicare, Medicaid or Commercial?
The Facility and Physician claims must be billed separate.

You should have two billing for the hospitals that indicate the admit date and time to avoid a claim denied as duplicate of services.

 

[mitchellde]

i code for facility and professional. The patient came in in the morning and at night for totally different diagnosis. Should i join everything to make a higher E/M or should they be billed separate with modifier 27? I am not able to find current information. Please help

The facilty will generate one claim with two line items with reve center 450 and and two E&M codes for the ER you will link the DX code for each E&M to the one it belongs to. The second E&M does get a 27 modifier attached. If a procedure was performed at either encounter, both E&M codes need a 25 modifier as well.
The physician will bill one E&M code which will combine with he complexities of both encounters.

 

[08pancho]

The coding was for commercial. My understanding of the previous reply is One claim with the 2 e/m level and 1 modifier and the diagnosis all together? I was thinking two separate claims since the diagnosis were different I didn't know how to separate the diagnosis. Or I can add all the diagnosis and e/m level and just send it along with the records.

 

[mitchellde]

Ok it is one claim for the facilty both dx codes, two lines for the E&M codes the second one with the 27 modifier. Do not submit two claims. There will be a G0 condition code on the claim that will communicate two visits in the same revenue Center.
The provider will submit one claim with one E&M

 

[08pancho]

Got it thanks for the help I appreciate it