Practice Management Alert

Question: If two physicians in the same group who are not in separate specialties see the same patient in the office on the same day, can we bill E/M services for both physicians?

Missouri Subscriber

Answer: No, you cannot bill two separate codes for the same-patient, same-day services. You would normally combine both E/M services into one code. CPT^® considers an E/M service's history and physical global for the day. Therefore, correct billing bundles same-day office visits together.

For instance, two internists in the same practice treat an asthma patient twice on the same day. In the morning, physician A prescribes new asthma medication for a patient who's been having occasional attacks and codes the encounter as 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...).

Later that day, the patient returns wheezing and sees physician B, who performs and documents 99214 with a nebulizer treatment.

If you submit 99213 and 99214 on the same day, the payer will reject one of the E/M services -- usually the higher-paying office visit -- as duplicate charges.

Better way: Combine the two physicians' work and submit one E/M code, such as 99215. You should also report physician's B procedures, such as 94640 (Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]; repeat procedure by same physician).

If the internists are in two different groups (not covering for each other), they should each bill the appropriate E/M service code. But insurers may require different ICD-9 diagnoses, such as controlled extrinsic asthma (493.01, Extrinsic asthma; with status asthmaticus) and exacerbated asthma (493.02, Extrinsic asthma; with [acute] exacerbation) for payment.