2 E/M Codes

cgraham

New
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4
Location
Roanoke, VA
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I need some guidelines for my Providers regarding billing 2 E/M services on the same dos. This issue seems to come up more often and I don't really think that it is appropriate. I would really like to be able to give them something in writing to address some issues. Any suggestions would be greatly appreciated. I need this as soon as possible.
Thanks
 

CoderChick24

Networker
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61
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Columbus, OH
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It depends on the situation. Is the patient being seen twice by one doc or different docs; in different settings or the same; for different conditions? The answer is generally that two E/M aren't paid on the same day, but the reference and answer would depend on the situation.
 
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164
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San Diego
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Hi,

In addition to the questions "acrego" posted, I know that two e/m's are appropriate to bill on the same dos when one is a "problem oriented" visit and the other is a preventative service. The cpt book actually tells you that this is allowed with the use of a -25 modifier and the instances in which this would be appropriate. Hope this helps!
 

raelewlov

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what is your email address? I would like to forwad you a copy of the 1995 and 1997 guidelines for E/M.
 

Ruth N Egipciaco

Contributor
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Newport News Virginia
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Hello,
Preventive Medicine Services on the CPT book, Evaluation & Management section, provides instructions when to report 2 (two) E/M services, the appropriate modifier to be used and what the codes include. Some insurances will pay for both reported services, others might not. Remember to obtain an ABN for MCR patients, most preventive services ara a statutory exclusion from the MCR program. G0344 Initial preventive physical examination services limited to new beneficiary during the first six months of Medicare enrollment, would be covered and should not be billed with another Preventive E/M service (eg. 99397). This is commonly referred to "Split Bill".
 
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