Denise Posted Wed 11th of February, 2015 12:11:13 PM
We have an Alabama Medicaid pt that had left ESWL (shockwave lithotripsy) of renal stone as outpatient by one of our dr's. Pt was discharged home. Later that evening he experienced severe left flank pain and went to the ER. He was subsequently admitted to our service (before midnight) as an inpatient (same facility) for a huge lt renal subcapsular hematoma. He was kept in the hospital for 5 days. My question: How do I submit the claim for the outpatient ESWL (90 day global) and the admission as inpatient with subsequent hospital visits when both have same date of service? Can I get paid for both the procedure and the inpatient admission for the postop complication? It is the same date of service for an outpatient and then inpatient that is confusing me. Plus Medicaid has their own rules and I cannot get a straight answer when I call. Will Modifier 24 and diffent POS suffice on inpatient claim? Thanks for any help!
SuperCoder Answered Thu 12th of February, 2015 03:28:56 AM
Yes, since inpatient service was rendered for post operative complication, you can bill both inpatient E/M and procedure on same date. Just make sure that you append modifier 24 with E/M code. Thanks !!