Wiki New Coder Question

[KellyRuth]

Hospital inpatient is seen for a progress note by Dr. A and then Dr. B is called later in the day because the patient is in afib. how do you code that second note?

 

[thomas7331]

If the two physicians are from the same practice and of the same specialty, then they are treated as if they are the same physician and you would combine the two notes into a single E/M service for the day. You'd usually bill that service under the physician who performed the greater amount of the work.

If these are physicians of different specialties or different group practices, then they're separate services and you would code and bill each one individually.

I'm assuming that the two services that day are both E/M services. Of course, if other procedures were performed, that would change things.