Wiki office visit/ER visit same day

[BABS37]

We had a patient that went to the clinic for her scheduled visit. She had some extensive bleeding in her nose and our physician said he couldn't do it in the office and that he wanted her to go to the hospital and he would cauterize her nose in the ED. He billed out for the office visit but now wants to charge for the ED visit along with the cautery at the hospital. Can he charge this since he sent her to the ED as a planned procedure to perform the cautery only?

Thoughts?

 

[Jashani1]

It can be billed however most insurances only reimburse for one visit per day. You may have to send in the documentation to have ir reviewed once the claim is processed.

 

[BABS37]

I know there can be multiple visits per day but I feel like since it is a planned procedure that it wouldn't warrant a separate ED charge is all. Has anyone else came across this type of problem? I feel like the patient got suckered... I'd be mad as a patient I guess...

 

[sullivak]

It's my understanding that he can only bill the ED visit and not the Office Visit, and that he can use what he did in the office to contribute to the ED code. In that setting, he can go ahead and bill the cautery.