2 E/M same day by same provider

SHobbs

Networker
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Columbia
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I am a little confused on how to do the billing for these visits, the visits were unrelated to each other so they should be billed two separate ovs correct? do I use a modifier on these or send in the notes with claim to show visits were unrelated? Any help is much appreciated.
 

mshay134

Networker
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Lincoln, RI
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SHobbs, a physician can only bill for one E/M per day. Generally the highest code is used. Again, you cannot bill two visits for the same physician on the same DOS.
 
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4,456
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Milwaukee WI
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One E/M but combine documentation

You may only bill out ONE E/M visit, but you may combine all the documentation from both visits to arrive at the level of service.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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Milwaukee WI
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Sick and Preventive

The only exception to this, of course, is if ONE visit is preventive, and the other is for a sick encounter. Then you may code both, and use the -25 modifier to show that the sick encounter is a significant, separately identifiable service.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 

maddismom

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I am a little confused on how to do the billing for these visits, the visits were unrelated to each other so they should be billed two separate ovs correct? do I use a modifier on these or send in the notes with claim to show visits were unrelated? Any help is much appreciated.
Was in the Medicare Claims Processing Manual a few minutes ago looking for something else and happened to run across the following:
30.6.7 - Payment for Office or Other Outpatient Evaluation and Management (E/M) Visits (Codes 99201 - 99215)
B Office/Outpatient E/M Visits Provided on Same Day for Unrelated Problems
As for all other E/M services except where specifically noted, carriers may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident).
Don't know if your payor is Medicare, but hope this helps.
 
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