Wiki Same Day E&M Visits

[TMB1965]

If a patient has been in rehab as an inpatient, and then goes to his Cardiologist during this time for a follow up visit in the office can the Cardiologist bill the E&M with a modifier 25? The Cardiologist claim was denied by Medicare because of the inpatient services. Any help would be greatly appreciated.

 

[skraft1969]

When this happens the claim must be billed to the SNF

When a patient is being treated in a covered part A Medicare inpatient stay either at the hospital or SNF and service provided as an outpatient would be denied.
If the provider saw the patient in his office while he was an inpatient then you can only get paid from the SNF. If the provider saw the patient in the SNF then you need to make sure you are billing the correct E/M code and the correct POS.
Please see the consolidated billing information that CMS has published.