BILLINGTWO STATUSESON SAMEDAY

Quest ion: Can w e no longer charge an em ergency room e/ m , and observat ion e/ m t oget her at all? In t he past w e could, and for Medicare w e added t he 25 In t he past w e could, but now w hen w e look in t he PARA calculat or, t he are "red", m eaning w e cannot charge t hem t oget her We are get t ing Medicare denials Can you please clarify?

Answ er: The American Medical Association (AMA) states that the same physician can bill visits from two different statuses on the same date of service if each encounter is documented separately Modifier 25 may be appended to the other E/M service to indicate a significant, separately identifiable service by the same physician or other qualified healthcare professional on the same date. However, CMSstated in their 2023 Proposed Final Rule that they will not follow these guidelines and will only pay for one visit on the same date of service by the same physician. Only time will tell if commercial payers choose to follow the CMSguidelines.

Medicare Claims Processing Manual (cms.gov)

30.6.9.1 - Payment for Initial Hospital Care Services and Observation or Inpatient Care Services

(Including Admission and Discharge Services) (Rev. 2282, Issued: 08-26-11, Effective: 01-01-11, Implementation: 11-28-11)

A Init ial Hospit al Care From Em ergency Room

A/B MACs (B) pay for an initial hospital care service if a physician sees a patient in the emergency room and decides to admit the person to the hospital.

They do not pay for both E/M services Also, they do not pay for an emergency department visit by the same physician on the same date of service When the patient is admitted to the hospital via another site of service (e g , hospital emergency department, physician?s office, nursing facility), all services provided by the physician in conjunction with that admission are considered part of the initial hospital care when performed on the same date as the admission