Pediatric Coding Alert

Question: Our practice has multiple locations, and they don’t all have the same equipment. If a provider sees a patient in one location and sends the same patient to another one to have a test done, do we need to submit a one claim for the office evaluation and management (E/M) service and another claim for the test to account for two locations, or should we submit one claim and merge the services since it’s technically the same practice?

AAPC Forum Participant

Answer: You will need to submit one claim per location. Submit the E/M service so the provider who ordered the test from the first location receives adequate reimbursement for their work. The second location will also submit a claim, but since an E/M service that led to the ordering of the test already occurred, the second location should only code for the test, not an E/M service. This is of course presuming that at the second location, the patient did not bring up a separate issue with the doctor performing the test.

If the patient did ask the testing doctor about a separate issue that’s unrelated to the test, and that doctor took the time to evaluate and manage the new issue, the visit would support an E/M as long as you also append modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to show that the E/M was unrelated and therefore warranted.