Neurosurgery Coding Alert

Question: Sometimes patients see two of our physicians on the same day. Can I submit an E/M code for both physicians?

Nebraska Subscriber

Answer: It depends on the physicians specialties:

" Same: When two physicians in the same specialty and same practice see a patient on the same day, you may see denials if you try to report an E/M service for each. Payers limit your option to one E/M service per day per specialty in the same group practice.

" Different: You can report two E/M services for one patient on the same day if the patient sees two of your physicians who have different specialties. If two neurosurgeons in the same group with different specialties see a patient on the same day, however, you should be compensated for both services.

Example: A patient sees your practices physiatrists for cervical instability (723.8, Other syndromes affecting cervical region) and pain (723.1, Cervicalgia) after a fall and then sees one of your neurosurgeons for assessment of possible meningioma. Because the physicians have different specialties, you may report both services. Assign a diagnosis code for the second service based on what the physician finds -- for example, 225.2 (Benign neoplasm of brain and other parts of nervous system; cerebral meninges) plus V15.88 (History of fall).

Your payers may reimburse on just one of the E/M services because they dont recognize physician subspecialties (such as cranial and spinal neurosurgeons). For example, Medicare does not recognize neurosurgical subspecialties, but does identify hand surgeons as distinct from orthopaedic surgeons.

You can try to appeal the denial with non-Medicare payers. Submit documentation for both services, showing that two different neurosurgeons performed the services,and explain the difference in the physicians expertise.