Neurology & Pain Management Coding Alert

Discover when you should combine E/M services and when you shouldn-t If a patient presents to your neurologist twice on the same day, you shouldn't count out the possibility of reporting two separate E/M services.
 
You can -- but be prepared to put forth additional effort to get your claim reimbursed.
 
Myth: Many coders believe that you can't bill Medicare for more than one E/M visit on the same day and that you should combine two or more visits into one.
 
Indeed, Medicare transmittal 1644 (August 1999) specifies, -Pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not.-
 
Reality: Although the above rule holds true for the hospital, payers will allow for exceptions in the office setting, experts say.
 
You may report multiple in-office E/Ms on the same day, but it can be difficult.

Unrelated Problems Are Key Medicare will pay for two office visits by the same physician for the same patient on the same day if the visits are for unrelated problems, according to the Medicare Claims Processing Manual.
 
Example: A new patient presents with a possible diagnosis of carpal tunnel syndrome (354.0). The neurologist provides a full E/M service, spending about 40 minutes taking the patient's history, performing an exam and, finally, deciding to conduct several electrodiagnostic tests, including electromyogram (EMG) and nerve conduction study (NCS), which he administers during the same visit.
 
Several hours later, the patient returns to the neurologist's office, stating that she has experienced vertigo and light-headedness after a car accident. The physician sees the patient in the office on an -emergency- basis and performs a second E/M related to the new complaint.
 
In this case, the neurologist sees the same patient twice on the same day for unrelated problems. At each visit, the physician has to provide a complete evaluation. Such cases are rare, but when they arise, you could be justified in reporting two separate E/M services.
 
Important exception: Whenever the E/M code descriptor specifically lists -per day- (for instance, 99218, Initial observation care, per day, for the evaluation and management of a patient ...), you must include all E/M services for that date in the claim no matter how different the diagnoses. Bulletproof Your Documentation Most likely your carrier will initially deny claims for two E/M visits on the same day, says Phyllis Klein, president of PK Administrative Services in Englewood, Colo. Unless the physician needs to use a critical care code (99291-99292) or reports prolonged care (99354-99355) in addition to the E/M code, the carrier probably won't know what to make of it, Klein says.
 
Ask yourself if it's worthwhile: -You-re going to have to send documentation, you-re going [...]