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Multiple E/M same date of service

  1. #1
    Default Multiple E/M same date of service
    Medical Coding Books
    I had recently been told by a claims representative that billing for multiple E/M codes on the same date of service (even by different providers for different problems, but in the same practice) was unacceptable "per CPT rule".

    As many coding things do, the logic escapes me if there were separately-identifiable services rendered to this patient. How would that differ from someone having two physician visits in different offices on the same date?

    I have reviewed my 2008 and 2009 CPT, along with archived CPT Assistant and have found no reference to this inference.

    Can anyone help?

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    "I had recently been told by a claims representative "

    I'm not a favorable party for insurance carriers. They will tell you anything to bypass a payment to the provider.

    30.6.5 - Physicians in Group Practice (Rev. 1, 10-01-03) 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.

    http://www.cms.hhs.gov/manuals/Downloads/clm104c12.pdf

    APPEAL

  3. #3
    Location
    Duluth, Minnesota
    Posts
    1,133
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    I've never seen "that" CPT rule! - perhaps the claims rep is "playing" coder -
    make sure you have a .25 modifier on one of those E/M's - and make sure the codes/dx's are linked accordingly,... there shouldn't be a problem with two visits, different reasons, different docs, same day. I agree with rebecca -
    APPEAL
    Donna, CPC, CPC-H

  4. #4
    Default
    I have that same Medicare payer language, but I still don't see anything with regard to CPT to back it up. I agree that carriers will say what they want and guide you incorrectly more often than not...without basis. I was just wondering if they really have something to fall back on that I wasn't aware of.

    Even in the Medicare language, it stated "unless it's for a different problem or condition" (paraphrased). Most often, if multiple providers within the same practice would see a patient on the same date, it would be for different problems anyhow...

    Thanks for your responses. So far, it looks like I'm not crazy!

  5. #5
    Location
    Madison Area Chapter in Madison WI
    Posts
    113
    Default
    As the Coding Compliance Analyst for a payer, I have to say I don't think ALL payers say things just to not pay. Because we, as payers, have so few professional coders who actually understand the rules, fallacies are often taken as truths. Fortunately more payers are recognizing the value of CPCs and we will see more in the future.

    Now, after saying that, here's my opinion.

    Pooh! Multiple E/Ms are absolutely appropriate if supported.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

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