AAPC - Back to school
Results 1 to 5 of 5

Thread: Multiple E/M same date of service

  1. #1
    Join Date
    Apr 2007
    Cleveland, TN

    Default Multiple E/M same date of service

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    North Carolina


    "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.



  3. #3
    Join Date
    Apr 2007
    Duluth, Minnesota


    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 -
    Donna, CPC, CPC-H

  4. #4
    Join Date
    Apr 2007
    Cleveland, TN


    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
    Join Date
    Apr 2007
    Madison Area Chapter in Madison WI


    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
    ccrsconsulting.com - website

Similar Threads

  1. Service date vs admit date
    By hollys in forum Inpatient Facilities
    Replies: 2
    Last Post: 12-28-2015, 11:17 AM
  2. Billing date of service versus date report was read?
    By tawnyagarrett in forum Cardiology
    Replies: 5
    Last Post: 08-21-2012, 08:53 PM
  3. Multiple Claims on Same Date of Service
    By Tracey Thompson in forum Billing/Reimbursement
    Replies: 4
    Last Post: 05-30-2012, 05:14 PM
  4. Place of Service and Date of Service
    By NESmith in forum Billing/Reimbursement
    Replies: 1
    Last Post: 10-07-2011, 08:52 AM
  5. Date of Service and Date of signature
    By arizona1 in forum Medicare Regulations
    Replies: 1
    Last Post: 04-20-2010, 02:50 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.