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Office visit for rehab pt

Kimberly Posted Tue 15th of November, 2016 16:23:12 PM
Patient came in to the office for a visit but Medicare is denying the office visit charge (in April 2016) because the patient was in a rehabilitation center (for a fall, unrelated to GI complaints/reason for office visit) at the time of the office visit. Is there a modifier that should be used?
SuperCoder Answered Wed 16th of November, 2016 06:33:14 AM


As per the above documentation, appropriate modifier would be 25 as it states “Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service”.

Since, the current visit (for fall) is unrelated to that of the previous visit, i.e. GI complaint, it is appropriate to code the service with appropriate evaluation and management service at place of service 11 (office).

Thank you.

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