Wiki Initial vs Subsquent

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Mindy Davis

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We are an ER group and we've had a patient come in following accident and a few hours later in the same day the pt returned. Normally under CMS guidelines we would combine the visits and up code the pt level. So having said that I don't see how we can use the old guidelines with ICD-10 when the 1st visit would be the initial and 2nd visit would be the subsequent. Do we now need to bill for each individual visit?

:rolleyes:
 
The 2nd visit is not necessarily subsequent. If the provider is still actively treating the injury the the second visit could be initial as well. The question is what was done in the second encounter?
 
Ok so yes it is subsequent. If this is the facility coding you can code two ER visits on the same day. However for the physician, I am not certain if you will be reimbursed on two with the same basic DX code. You may need to add the two together and bill as initial for one encounter. Until the payers change theirs rules on some of these issues ICD-10CM will not work as perfect as it should.
 
It's physician billing. I remember asking this exact question during our ICD-10 boot camp and I wasn't giving a straight answer because no one knew for sure. I'm going to try to bill both visits and add a 25 modifier to the 2nd one. We use to have to do that in family practice for BCBS when a pt came back on the same day for non related problems.

Thanks for your help!
 
Yes for non related. But this is related and some payers still attach a 10 day global to laceration repairs so you may run into that as well.
 
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