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Shared visit

  1. #1
    Default Shared visit
    Medical Coding Books
    I have two physicians that have a joint clinic. They have different specialties. Both physicians are seeing the patient at the same time in the same room. The tax ID is the same for all my physicians. This is done for the patient's convenience. I'm not in the room but am assuming that they are not both doing ROS, HPI and MDM. Time is stated in both notes.

    Is it allowable to bill E/M visits for this scenario? The first visit they also billed new patient exams. I've never encountered this before.

  2. #2
    Location
    Las Vegas, Nevada
    Posts
    81
    Default
    Found this on Codapedia. Hope it helps. Thanks for the opportunity for me to learn as well.


    Two office visits on the same day

    Medicare will only pay for two office visits on the same day, if they are unrelated. A second office visit billed on the same day to the same patient for the same condition is not payable. If a patient is seen in the morning with an acute or chronic problem, sent home from the office, and returns later either at the physician's request or because their symptoms are worse, report only one visit. The level of service selected may be based on the documentation for both services. If the second visit is all provider face-to-face time with the patient, consider using prolonged services codes. Review the rules for that in the Codapedia article on prolonged services.

    From the Medicare Claims Processing Manual, Chapter 12

    B Office/Outpatient E/M Visits Provided on Same Day for Unrelated Problems
    As for all other E/M services except where specifically noted, carriers may not pay two
    E/M office visits billed by a physician (or physician of the same specialty from the same
    group practice) for the same beneficiary on the same day unless the physician documents
    that the visits were for unrelated problems in the office or outpatient setting which could
    not be provided during the same encounter (e.g., office visit for blood pressure
    medication evaluation, followed five hours later by a visit for evaluation of leg pain
    following an accident).

    - See more at: http://www.codapedia.com/article_126....udNyiFE1.dpuf

  3. #3
    Default
    Thanks for that resource. The specialties are different. One physician is pain management and the other is Othopedic surgeon. They are in the room at the same time. I think they should see the patient separately.

  4. #4
    Location
    Coeur d'Alene, Idaho
    Posts
    134
    Default
    I agree with you that the patient should see each physician separately. How else would you truly know if each physician did a separate physical exam, review of systems, etc?

    Just my thoughts.

    Thanks, Amanda CPC, CCC, CEMC

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