Wiki 2 visits in one day

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My question is:

Patient comes in to see the doctor in the morning and he orders a Ultra Sound and has the patient come back in the afternoon after he has the results of the US. Patient has has a Missed Abortion and then sends her to the hospital that evening for a D&C. He has documented to seperate notes in our EMR system for the visits. How would I bill the E&M?

I am thinking I can only bill 1 visit.
Thanks for any quick response:)
 
I would say combine the documentation and bill for one visit if it was the same issue. However per Medicare e/m manual you can add 76 modifier:

"76 Modifier Repeat procedure by same physician: use to indicate that a procedure or service was repeated subsequent to the original service

Use the 76 modifier when billing for separate office or outpatient E/M visits that occur on the same date of service (only for codes 99211–99215) by the same physician/practitioner.

Each service should be clearly documented.

Use the 76 modifier to indicate a separate encounter occurred on the same date of service when separate services are billed. Do not use the 76 modifier for the initial visit.

Example of Proper Usage

A patient visits the physician on Wednesday morning for a bladder infection. She is treated and sent home. That same afternoon, the patient returns to the physician's office with a twisted ankle. Each service should be reported with the appropriate level of E/M service with the 76 modifier added to the second visit for the twisted ankle."

Thanks,
Sofia MS,CPC
 
Notice in the example Sofia gives the two visits are for completely different problems. That is not the case for your doctor. I would combine the documentation and bill one visit. I am guessing if she could have had an immediate u/s, she wouldn't have had to "come back later". The two visits are related.
 
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