While payer policy will dictate payment, this scenario calls for appending modifier 25 (significant, separately identifiable E/M service) to the code for the care provided in the hospital. National Correct Coding Initiative edits pair initial hospital care codes with preventive medicine E/M service codes. Individual payers may or may not use these edits. It may be beneficial to contact the payer about the plan’s policy for same-date E/M services and learn if automated claims processing edits are set to deny either of the services when submitted with modifier 25. If edits would typically result in a denial, the payer may be able to advise whether submission of a narrative statement on the claim (eg, note, “Services provided at separate encounters on the same date,” in the electronic equivalent of field 19 of the 1500 paper claim form) or medical records submitted as an electronic claim attachment would trigger manual...

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