Even though the 2 services are provided by different individuals within your group practice, a health plan’s edits may disallow the hospital visit when provided on the same date as a procedure. Individuals who are considered to be in the same specialty and subspecialty (usually designated by the individual during credentialing with the health plan) within a group practice are treated as 1 individual for purposes of claims payment. However, appending modifier 25 (significant, separately identifiable evaluation and management [E/M] service) to the code for the hospital visit (eg, 99462 25 for subsequent hospital care of a normal newborn) alerts the payer that the E/M is separately identifiable in the health record and was significantly beyond the preservice work of the circumcision.

The ICD-10-CM guidelines state, “During the COVID-19 pandemic, a screening code is generally not appropriate. For encounters for COVID-19 testing, including preoperative testing, code as exposure to COVID-19.”...

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