Ob-Gyn Coding Alert

Caution: Be on the lookout for E/M descriptors that say -per day- If a patient presents to your ob-gyn twice on the same day, you shouldn't count out the possibility of reporting two separate E/M services. You can -quot; but be prepared to put forth additional effort to get your claim reimbursed.
 
Myth: Many coders believe that they can't bill Medicare for more than one E/M visit on the same day and that they 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: The patient arrives early in the day with vaginal pain. The ob-gyn examines the patient, diagnoses
an imbedded vaginal polyp (for example, 623.7, Polyp of vagina) and recommends outpatient surgery.
 
Several hours later, the patient's husband brings her back to the ob-gyn's office, stating that while shopping nearby the patient tripped and hurt her ankle severely and now cannot walk. 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 ob-gyn 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 to have your payments delayed, and the patient's going to have two co-payments,- says Barb [...]