Wiki Hospital visit, then office treatment same day

[ChristieH]

My ID doctor sees pt in the hospital for consult of an infection. Patient is released and comes to our office the same day to start antibiotic infusion therapy. We have tried using modifier 25 on the hospital visit (99232) and also tried using no modifier. Medicare along with other payers will only pay on the infusion treatment and deny the hospital visit. Does anyone know of a modifier that will help us get paid for the hosp visit? I'm at a loss, but we feel the doctor should be paid for the service provided. Thanks for your input.

 

[Siva03]

have you billed any other E&M code for that DOS? I suspect that you would have billed a consultation coded for the same dos, followed by 99232 and infusion. Per guidelines two E&M services cannot be billed on the same day. So the CPT 99232 would be denied.

Thanks,
Siavkumar CPC, CPC-H