Wiki Help

Create Wiki
A

annchan97

New
Messages
5
Best answers
0
Looking legally, should a physician split his charge for an E/M and a procedure that is done in the office on the same dos to two claims for processing, for hospital based providers. I understand for normal circumstances that we would add a modifier 25 to the E/M. Please advise or direct me to information to clarify this issue. Thanks Ann
 
Unless the E/M service was absolutely necessary, I would just bill the procedure. If the OV was necessary bill them both and use the modifier, you will probably need to submit office notes to substantiate the OV though.
 
For physician reporting: E/M should be billed if something more than a normal preop service is done or if it is done for a different problem.

For facility reporting: Should report both.
 
annchan97 said:
Looking legally, should a physician split his charge for an E/M and a procedure that is done in the office on the same dos to two claims for processing, for hospital based providers. I understand for normal circumstances that we would add a modifier 25 to the E/M. Please advise or direct me to information to clarify this issue. Thanks Ann
Click to expand...

You cannot submit 2 claims for a single physician encounter, they will just reject for duplicate claim. If your service meets the criteria for an assessment that is over, above , and beyond the reason t=for the procedure then you bill one claim with the ov and 25 modifier and the procedure. You do not need 2 different diagnosis for this to be a payable claim. Facilities have the same rule for this. If a procedure is scheduled and whether it is physician or facility then an E&M may not be charged as there is no assessment or service beyond what was already planned to be done.
I am uncertain why you thought you would need to submit 2 claims though.
 
The billing staff has been directed to split the charge for E/M and procedures. Some of the other coders in the office and myself stated that is incorrect, but the reply was we are hospital based and that is how it has to be done.

Thanks
Ann
 
You must log in or register to reply here.
Top