Optimal Coding for Same-Day Multiple Visits
Published on Thu Apr 01, 1999
Its not unusual in pediatrics for an infant or child to come in in the morning with a problem and return later in the afternoon or evening with the same problem, which has become exacerbated, or perhaps with an entirely different problem. What is the best way to code for such visits?
First of all, you can only use one Evaluation and Management (E/M) Services code per day, unless you do something entirely different on the second visit. This means that you had better choose that one code very wisely. Even if you see a child three times in one day, and end up admitting him or her to the hospital, you can only use one E/M code and, in this case, that would be the hospital admission code (99221-99223), says A.D. Jacobson, MD, FAAP, of Pediatric Associates in Phoenix, AZ, and editor of Coding for Pediatrics, published by the American Academy of Pediatrics (AAP). But, if you see the child three times in one day, you could justify using a higher-level hospital admission code than you would if you hadnt seen the child in the office once or twice earlier that day.
The basic rule to follow is this: Use a higher level code if you see a child more than once in a daybut use it only once. However, in order to support this code, you must do more work (i.e., the level of decision-making must be more difficult) and you must be sure to document carefully to support the higher level. (See page 27 for tips on how to pick the appropriate level of service.)
Multiple Diagnoses
Jacobson has found that asthma is the most common condition in pediatrics that results in multiple visits on a single day. Maybe its a level three office visit (99213) the first time you see the child with a diagnosis code of extrinsic asthma (493.0), he says. Then they go home, but return in the afternoon with acute distress. For the second visit, you would use the fifth digit on the ICD9 Codes, indicating status asthmaticus (493.01). The second office visit would be coded either a fourth or a fifth level office visit (99214 or 99215), says Jacobson, depending on how much work you did for both.
The first superbill should be disregarded altogether; just move the diagnosis of 493.00 to the list on the second visits superbill, explains Jacobson. This means you would have extrinsic asthma without status asthmaticus (493.00) and extrinsic asthma with status asthmaticus (493.01) on the same claim form attached to the level four or five office visit. Remember, its the [...]
