Two visits in one day


Richlands, NC
Best answers
I’ve been a coder for eight years. Recently there is come up some things at work and we had two separate providers in our facility see the same patient in one day. It is not ethical to not bill the second visit? From my understanding and knowledge of previous experience both visits have to be billed no matter what. Do any of you Disagree? If so, why?


True Blue
Best answers
If both providers are the same specialty in the same group seeing the patient for the same problem, you may combine the work of both visits and bill 1 visit (at possibly a higher level based on both notes).
If providers are different specialties, or there is a different reason for the visit, you may bill both visits. It will initially be denied, but you may appeal.

Per Novitas:
1. Is modifier 25 reported on the second encounter if a physician sees a patient in the office in the morning and again in the afternoon for a new or worsened condition?
No, modifier 25 is used to identify a significantly, separately identifiable E/M service performed by a physician on the same date as a procedure or other service. Novitas Solutions would not expect to see two E/M services reported on the same date on a routine basis. The physician would be expected to combine the documentation and bill only one E/M.
2. In rare circumstances, would a physician bill a second E/M service on the same date of service for the same patient?
If a second E/M service is required on the same date of service, the documentation should clearly provide evidence of the second E/M service occurring, the reason for the additional E/M service, and documentation of the medical necessity of the second E/M service. When reporting a second E/M service on the same date, the service will initially deny. You can appeal the denial with documentation. Information on the appeals process is available in the Part B Appeals Reference Guide.
4. Can two physicians in the same group practice, who see the same patient on the same day, each bill for an E/M service and receive payment?
Physicians in the same group practice but who are in different specialties may bill and be paid separately without regard to their membership in the same group.
Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.
Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM) Publication 100-04, Claims Processing Manual, Chapter 12, Section 30.6.5