Expect Denial When Reporting 2 E/M Services on Same DOS
Question: One of our physicians saw a patient in the morning, and then again in the afternoon after they started exhibiting new symptoms they found concerning. Can I bill for two evaluation and management (E/M) services since the physician saw the patient two separate times? Pennsylvania Subscriber Answer: According to Medicare Administrative Contractor (MAC) Novitas Solutions, a provider could bill for E/M services on the same date of service (DOS), but the supporting documentation would need to be pretty extensive to secure reimbursement. In fact, providers who do this should expect a denial, and would need to appeal the denial with supporting documentation. Novitas says: “If a second E/M service is required on the same date of service, the documentation should clearly provide evidence of the second E/M service occurring, the reason for the additional E/M service, and documentation of the medical necessity of the second E/M service. When reporting a second E/M service on the same date, the service will initially deny as only one E/M is reimbursable per day, per patient, per physician or same group, same specialty You may appeal the denial with documentation. Novitas Solutions would not expect to see two E/M services reported on the same date on a routine basis.” Of course, you should check with the patient’s respective payer to make sure you’re following its specific guidelines. You can find information on the appeals process concerning Medicare beneficiaries in the Part B Appeals Reference Guide. Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC
