¶¶Òô´ó¹Ï members may submit coding inquiries electronically to codingquestions@asge.org. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ¶¶Òô´ó¹Ï member’s name and ID number. Only questions will be accepted and not reports. Below is our featured Coding Question of the Month that could be beneficial to your practice.
Question: A provider wants to do an office visit the same day as the patient’s infusion since the patient is coming back from college. If we do that, can we add a modifier to get paid for both? If we bill the office visit, are we risking not getting payment from the infusion? Our obvious concern is if we bill a same day visit, they may not allow for the infusion or the administration of that infusion.
Answer: If there is a separate office visit by the provider that either addresses something unrelated to the UC modifier or makes other recommendations, etc. then the visit could support being "significantly separate" and modifier 25 would be added to the visit. However, if the visit is just to see how the patient is doing prior to the infusion, then that is considered part of the preprocedural evaluation and not separately billable. Your risk would be not getting paid for the visit and potentially setting the provider/practice up for review by the payer if this is a "repeating" issue for routine visits prior to the infusion service.