Correctly Code for Same-day Multiple Visits

Its not unusual for an infectious disease patient to come in the morning with a problem and return later in the afternoon or evening with the same problem, which has become exacerbated, or perhaps with an entirely different problem. What is the best way to code for such visits?

For Medicare patients, the ID physician would bill the related office visit code plus an additional code known as prolonged evaluation and management services, says Mike Lewis of Matheison Moyski Celer & Co in Wheaton, Ill. There are threshold times necessary to bill for prolonged office visits (99354) and threshold times necessary to bill for codes 99354 and 99355 that involve the amount of time spent with the patient at the initial visit and the additional time spent with the patient in the afternoon (see box on page 23), Lewis points out.

Therefore, Lewis says, the physician needs to indicate in the initial visit the amount of time spent with the patient, and then, on the second visit, needs to document the work furnished and again estimate the time spent with the patient. For example, he explains, if the first visits documentation reflects an established visit level 3 (99213), then the patient returns the same dayeven for the same diagnosisand the total time for both visits equals more than 45 minutes but less than 75 minutes, the physician would bill 99213 and also 99354.

Problems can arise, Lewis says, because the physician, at the initial encounter, is not aware that the patient may return the same day. When the patient returns the same day, the physicians office should remind the physician and ensure that the physician indicates in the notes the combined time spent with the patient for both visits, he says.

According to Ron L. Nelson, PA, president of Health Services Associates Inc. in Fremont, Mich., and chairman of the board of the American Academy of Physician Assistants, the single billing for an ID patient for two visits really encompasses all the services provided in that day and could allow you to expand to another level of coding, either under the evaluation management or consultation category.

Multiple Diagnoses

In addition, the more different diagnoses you have, the more likely you will be able to use a higher E/M code, adds A.D. Jacobsen, MD, FAAP, of Pediatric Associates in Phoenix. If there are two totally different diagnosesone in the morning and one in the eveningthat would lend itself to a higher level, says Jacobson. Anytime you have multiple diagnoses, you have a more complicated problem, which increases the difficulty of your decision-making. Medical decision-making is a key factor in the level, Jacobson explains.

Indeed, Nelson says, the E/M code may involve your [...]

- Published on 2000-05-01