General Billing questions

Hello- Our advanced practice folks here have been having some questions that I am not 100% sure on how to answer so I was hoping someone could have some insight on them...

1- Can we bill an office visit on the same day as we do a bone marrow biopsy(38820 and 38821)?

2- If they see a patient in the office- it is warrented to be sent to the hospital- they arrive and our practice is not the admitting doctor- can we bill our office visit?

3-When they are doing chemo teaching and genetic testing counseling- what is the best way to bill for this? Regular office visit and then add the time spent counseling the patient?

Thank you in advance for any help that you can give!

General Billing Questions

For the first, you can bill an office visit on the same day as a bone marrow biopsy, as long as it is a significant separate service. If the patient comes in for a visit and at that visit it is determined that the patient needs a biopsy, yes, bill both. If the patient is scheduled for it at another encounter, bill only for the bone marrow biopsy. See all the articles on modifier 25 for more info.

You can bill the office visit, and I think most payer will pay it because you are a different specialty than the admitting MD. Some might deny it if the diagnoses are the same, but your specialty code should protect the claim and allow it to be paid. The only concern: are you then called in to "consult" the next day? I'd be cautious: bill a subsequent hospital visit, because your opinion isn't really being asked for: you are co-managing.

For the third, look at the article on prolonged services, I think.

Chemo Teaching

When it comes to Chemo Teaching you can bill a 99211 for the Nurse assess when the physician is in the office. If the physician is doing the chemo teaching, the counseling part of the office visit time would also include the teaching time. If the chemo teaching is done the same day as a physician visit, bill for the 99212-99215. I hope this helps.

Office visit on same day as hospital

[2- If they see a patient in the office- it is warrented to be sent to the hospital- they arrive and our practice is not the admitting doctor- can we bill our office visit?]

I am also curious about this, but to extend the question (and answer from previous), if the patient was seen on the same day in the PCP office for a regular check up, what are the guidelines when they return and are then sent to the hospital. Can we still bill a second office visit since the return was for emergency type services, not a check up?

Of course you can bill for it...

If you see a patient that is ill and send for admit, you can bill the office visit! Your assessment should include send to hospital for evaluation. The hospitalist or PCP will bill the H&P and if you are consulted then you can bill an inpatient consult too.