Wiki Several questions

[msjudy71655]

1. When using 1700 and 17003. We do charge an office visit with modifier 25. Then 1700 by itself. 17003 w/modifier 59, but the units are (lets say) 2. Now the CPT guidelines state to list them separately. I have tried both ways but have not been able to get the 17003 paid.

2. Patient comes to clinic has an ekg, or other tests, performed and was admitted. Now all of sudden! ins is denying the initial admit due to office charges. Does modifier 27 apply to this situation and does it attach to the hospital admit?

3. I am instructed to code as outpatient, pos 22, if pt is admitted for chest pains but the discharge is 21. I am confused on that "direction!" Does it really matter why a pt was admitted to direct what is in/out patient?

Thanks for your response.

Judy

 

[mitchellde]

1. When using 1700 and 17003. We do charge an office visit with modifier 25. Then 1700 by itself. 17003 w/modifier 59, but the units are (lets say) 2. Now the CPT guidelines state to list them separately. I have tried both ways but have not been able to get the 17003 paid.

2. Patient comes to clinic has an ekg, or other tests, performed and was admitted. Now all of sudden! ins is denying the initial admit due to office charges. Does modifier 27 apply to this situation and does it attach to the hospital admit?

3. I am instructed to code as outpatient, pos 22, if pt is admitted for chest pains but the discharge is 21. I am confused on that "direction!" Does it really matter why a pt was admitted to direct what is in/out patient?

Thanks for your response.

Judy

1. To bill an office visit with any procedure you must make certain you have met the parameters of the 25 modifier, in short the office visit must be over, above, and beyond the evaluation for the necessity of the procedure. Second when you are billing multiple lines of an add on code, the 59 goes on the second one
17000
17003
17003-59
2. You cannot bill an office visit and an admit on the day. The 27 modifier is for the facility, it cannot be used for physician billing. You may bill the admit with a 25 modifier and your EKG
3. If the patient is a direct admit the will be no outpatient charge for your provider ou bill only inpatient POS 21. Only if you admit to observation will you use a 22 modifier as observation is outpatient. If the provider converts the patient to inpatient status after they have been discharged then you will need to submit a corrected claim for you admit and convert it to inpatient.
I assumed you were inquiring regarding physician billing, if not then let me know.