Per CPT, no distinction is made between new and established patients in the ED. We bill for both visits and apply E/M codes per documentation and add modifier 27 to the 2nd visit.Hi, I work for a billing co that does Er billing and my understanding of your question is...if the pt is seen twice in one day by the same doctor with the same dx...then you can bill the first visit out to an 85 or however far it codes out to. The second visit you will be as an established pt, ( or recheck) and it should only code out to an 81 or 82 ( improving or worsening). If the patient presents a new problem in the second visit, like at the first visit they had a cough, but at the second visit they have a cough and knee pain, you can code the second visit as a new pt, not established, and code it out that way. But the doctor has to state the new problem, if there is one. Does that make sense?
If the pt is seen first by one doctor and then by a different doctor both with the same dx....I'm not sure I can answer that because the doctors I deal with are all in the same group. So if the doctors you are asking about are in the same group....the same answer as above applies. If the 2nd doctor is in a different group than the 1st doctor hopefully somebody can answer that for you. Hope that helps