Wiki Inpatient admit and consult code - modifier 25?

[nantes1993]

Patient was admitted to hospital (99221) for DVT and later that day a specialty physician for pain management did a consult (99254) which was paid. The denial is stating the 99221 is inclusive with the 99254. Is it possible to add a modifier 25 to the 99221 even though only the consult was done and no other procedure? Thank you.

 

[mitchellde]

Your provider cannot perform both. If your provider performed only the admit you need an AI modifier on the 99221.

 

[twizzle]

Your provider cannot perform both. If your provider performed only the admit you need an AI modifier on the 99221.

I think two different providers were involved. If 99254 paid then this is not MCR so AI would be inappropriate. Assuming these two providers are not in the same group, then both these encounters should pay without a modifier on either. If they are in the same group but different specialties, then a 25 modifier would be appropriate.