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:)


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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."

Sofia MS,CPC


Local Chapter Officer
Kansas City, MO
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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.