Wiki Please Help E&M Guideline

[stephmarie73]

Hi, is anyone aware of a guideline that gives direction on the correct billing if a patient see's 2 different MD's of the same specialty , on the same day, with different problems.?Same taxonomy code. Thank you in advance..

 

[thomas7331]

There isn't a coding guideline for this, but most payers have policies that treat two providers of the same specialty and in the same practice as if they were the same provider. Many payers also have policies that will only reimburse one E/M per provider/specialty per date of service, although some will make an exception if the patient returns for the second visit on the same day for a completely unrelated reason that was not addressed at the first visit, although in my experience this usually requires that you appeal the initial denial with medical records. If you run into this situation, the best place to start is to review the patient's insurance plan's policies.