Ob-Gyn Coding Alert

Question: One of our doctors saw a patient in the office (99213) with a diagnosis of pelvic pain. Later that evening, the patient went to the ER (99283) and was treated by another physician in our group. The patienthad an ultrasound (diagnosis: ovarian torsion). I know that I cannot bill two services on the same day, but how should I report this? Should I combine both services to raise the level of service rendered?

Texas Subscribers

Answer: You're right. You cannot bill two related office services on the same date, nor can you bill an office and inpatient visit on the same day.

You can, however, bill an office visit (99213, Office or other outpatient visit ...) and an emergency room (ER) visit on the same day (99283, Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history, an expanded problem-focused examination, and medical decision-making of moderate complexity), so long as the second physician does not subsequently admit the patient. CPT rules do not prohibit this, nor does Medicare.