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.