Help

Pt was seen on July 9th with bad symptoms, gave him a shot and got worse. So, doc decided to send him to E/R on the same day. Doc saw the pt at the hosp on that day. Do I need to bill the O/V or bill the hosp visit? I know we can't bill both. Can I bill the shot with no office visit? thanks!

re: Help

You are correct. You cannot bill both. Was the patient admitted into the hospital? Did your provider admit him, visit in the ER only, or visit as inpatient?

re: Help

You need to bill the hospital E&M with the appropriate POS (in/out). You can include the time and work that the physician spent in the office in choosing the level. You can also bill the shot with the office POS. You will need modifier 25 on the (hospital) E&M.

re: Help

@ youngblood: is that going to be one claim for shots and hosp E/M? but the shot was done in the office, so thats a diff POS.
So, I have to put mod. 25 on the hosp E/M? I have never done that. Do I need to make a separate claim for the shot and the hosp visit? Im confuse.

re: Help

I checked the NCCI edits and it looks like you cannot override the injection - assuming you intended to bill 96372 - being bundled to the inpatient E&M, so you will not need to add the modifier. If you supplied the injectable, you should try to bill that to cover your cost. Two separate claims for office vs. facility POS should work.

re: Help

Thanks so much! I appreciate it..

re: Help

Pt was told to go to the E/R and end up being admitted due to severe condition. So, doc visited pt at the hosp as inpatient on that same day.