Wiki Pcp/inpatient rounding

[tgclarke]

A patient was treated by the pcp at the office (99214) then went home. Later on in the same day the patient was taken to the hospital (not because the pcp suggested but because the daughter wanted the patient to go). The pcp is also on the inpatient rounding team and later treated the patient in the hospital (99223). The 99223 is hitting up against the 99214 stating bundled and I don't know how to fix this. Any suggestions?

 

[Tonyj]

A patient was treated by the pcp at the office (99214) then went home. Later on in the same day the patient was taken to the hospital (not because the pcp suggested but because the daughter wanted the patient to go). The pcp is also on the inpatient rounding team and later treated the patient in the hospital (99223). The 99223 is hitting up against the 99214 stating bundled and I don't know how to fix this. Any suggestions?

You can only bill the admission. If your physician was the admitting you'd append an AI modifier if the patient is on medicare. You can not bill an O/V same day as an admit.

 

[wrightju1]

If the patient was seen in the hospital for something other than what they were seen in the office for you can add the 25 modifier to the hospital services, but be prepared to send records to explain. For example she went to the PCP for pink eye and later that day went to the E/R for chest pain. Or she sees an orthopedist for arthritis, but goes to the E/R for a fall/fracture.
But otherwise you would combine the two records for coding purposes and it would likely be a higher level of hospital care.