2 sick visits in one day

Deb Pugh

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Flagstaff, AZ
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I was told today by a student of a coding class that if a patient came in for a sore throat in the morning and then saw the same provider for a cut finger in the afternoon that it would committing fraud to bill for 2 separate E/M codes. Is that true? I was under the impression that if it were 2 separate diagnsosi codes that you could bill for the second visit with modifier 25. Is there a rule somewhere? Thanks in advance for your input.
 
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31
Location
Lebanon, New Hampshire
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I was told today by a student of a coding class that if a patient came in for a sore throat in the morning and then saw the same provider for a cut finger in the afternoon that it would committing fraud to bill for 2 separate E/M codes. Is that true? I was under the impression that if it were 2 separate diagnsosi codes that you could bill for the second visit with modifier 25. Is there a rule somewhere? Thanks in advance for your input.
Per the Evaluation and Management Services Billing Guide from our regional Medicare, NHIC, Corp. 14

E/M Visits Provided on the Same Day for Unrelated Problems Contractors 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).

Check with your regional carrier to see if their advice is the same.
 
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