EM Coding Alert

Question: A parent brought in their two children for follow-up visits of their chronic asthma. Currently, one sibling is suffering from acute sinusitis and the other sibling is experiencing acute bronchitis. The pulmonologist spoke with the parent for 30 minutes and counseled them for about 15 minutes on how to use a nebulizer, since the parent had never used one before.

How do I bill the time spent with two patients in the same visit?

Texas Subscriber

Answer: You have two options for billing a scenario like the one you’ve described. One option is to bill the visit based on time. The second option is to create two separate encounters — one for each sibling — and count just the time spent for each patient.

For example, if the physician spent 30 minutes with each patient, which includes 15 minutes for counseling, you’d assign 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) to each claim. The documentation should include what the provider discussed for each patient and how much total time was spent.

Reminder: The provider can also bill based on medical decision making (MDM). By examining the notes for each patient in the encounter, the physician can easily identify each patient’s history, MDM, and physical exam, and then bill according to the MDM for each patient. This allows the physician to choose the option that best suits the amount of time and care delivered to the patients.