Do you know where I could find that in writing? I have looked through the E/M Guidelines and don't see anything that says one e/m per day per physician. Thanks for all the help.
Multiple E/M Services
Only one E&M service code per patient, per physician, per day is eligible for reimbursement, with
the following exceptions:
Two separate visits occurred at different times of day and for unrelated problems that could
not be anticipated or addressed during the same encounter.
o For example, a scheduled office visit occurs in the morning for upper respiratory
infection and 4 hours later an unscheduled visit for a fall with injured knee.
o Modifier 25 would be appended to the second visit. Additional information
regarding the two separate times should be supplied in box 19 of the claim form, or
the equivalent field in the electronic claims submission process.
o Note: If the patient mentions the second problem at the first visit, and the provider
asks the patient to return later in the day for the assessment of the second problem,
then all evaluation and management services provided that day would be included
in the selection of a single E/M service code.
Multiple Evaluation and Management (E&M)
Visits on the Same Date of Service
Empire will allow only the E&M service with the highest
allowed value when more than one E&M service is
billed for a member for a given date of service for the
same or similar condition. This policy is adopted from
CMS and also defines the provider according to their tax
identification number (TIN) and specialty.
If more than one E&M service per day is reported by the
same provider, the provider should bill a level of service
representative of the combined visits.
Multiple E&M Services - When multiple providers using the same federal tax identification number perform evaluation
and management (E&M) services on the same patient, on the same day, for the same or related condition, Harvard Pilgrim
will reimburse only the E&M service with the highest allowable amount. Harvard Pilgrim’s policy is to reimburse
for only one E&M service per day under the above conditions, regardless of whether services are performed by providers
with different specialties.
UnitedHealthcare will allow modifier 25 to indicate a significant and separately identifiable E/M service when a second physician in the same group and specialty provides a separate E/M service on the same day for an unrelated problem. However, there are instances when modifier 25 would not be appropriate to report, including but not limited to, reporting two E/M services where one is a "per day" code or reporting separate services when a more comprehensive code exists that describes the services.