AAPC - Back to school
Page 2 of 3 FirstFirst 123 LastLast
Results 11 to 20 of 22

Thread: 2 office visits on same day

  1. #11


    AAPC: Back to School
    I agree to combine the visits. You may want to check with the insurance carrier. I know our BCBS does not recongize modifier 25 in any case. Our Medicare will only pay one E/M visit per day, same for Aetna and UHC.

  2. #12

    Default Same day Visit 2 different specialities same tax id #

    Established pt came into clinic for PHE . Pt also scheduled to see Pod. for her ingrown nails. How would i bill and would i get paid since both Doc's are in the same practice using the same tax id #?

  3. #13


    Guideline is: 2 visits ....different specialties = 2 E&M codes

    First you have to determine if the patient is NEW or EST with each specialty

    A new patient (99201-99205) is one who has not received any professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years. An established patient (99211-99215) is one who has received professional services from the physician, or another physician of the same specialty who belongs to the same group practice, within the past three years.”

    You didnt say what specialty was doing the preventive visit. But lets say it is a FP physician and the patient is an established patient to FP. So he gets an Est patient preventive E&M code (99391-99394 etc) with the appropriate V code DX.

    The podiatrist, same group but different speciality. Let's say the Pt is a New patient to podiatry. He codes the appropriate 99201-99205 for the eval of the toenails. If he does any procedures then you will have to see if the documentation supports a separate E&M (mod -25) or his eval becomes inclusive to the procedure as "pre-procedure work".

  4. #14
    Join Date
    Apr 2007


    Ok, so I kind of have the same issue. Patient came in for a sports physical. The patient then came back later in same day for an inhaler refill. We billed two seperate visits with 2 different diagnosis codes. The insurance is denying as 2 e/m codes in same day. What would we do to get paid on this? Same tax id and specialty, but 2 different providers. Please help! Thanks

  5. #15


    2 physicians -- same group---same specialty---2 different DX ---should mean 2 E&M codes. But the paste below is CMS guidelines. Non-Medicare payers can make their own payment guidelines.

    You didn't say so I am assuming your sports physical met the guidelines for preventive and was coded as preventive while the med refill was coded 99212-99215

    I can see that the payer would question a 2nd visit for a med refill when that is a such a basic component of a preventive care visit. I could see the payer asking why the med refill was not done during the preventive encounter, expecially since both physicians are the same specialty. Payer could also question why the routine med refill was not done as a f/up phone call or nurse visit (extension of physician's visit). Did the patient just forget to ask for this inhaler refill when he was seeing the physician?

    Physicians in Group Practice

    Physicians of the same specialty in the same group practice must bill and be paid as a single physician.

    If more than one E/M (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 E/M service may be reported unless the E/M services are for unrelated problems.

    Physicians in different specialties in the same group practice may bill and be paid without regard to their membership in the same group.

  6. #16


    I have a question.. If we have an Orthopedic Hand Surgeon and a PA evaluate a New patient on the same day for different issues/diagnosis.. are we then able to bill 2 NP evals under 2 different providers within 1 group.. This patient has HN - please reply asap.. pending denied claim and coding conflict.
    thank you

  7. #17


    The most common practice is to report a single visit code per day, evaluating all services provided during that day to arrive at the correct level of service. Prolonged service codes may be used to report services beyond the usual."

    where is the CPT can I find the quote above???

  8. #18

    Default kinda same issue

    I had a physician seeing a patient yesterday for edema and during the exam he sees that she now has a new onset of DM, he bills for his visit and then our PA saw the patient to do the DM teaching (upon patient request that she lives to far away to make a special trip in just for the teaching) which we are able to bill under the PA and just get reduced reimbursement. I am not sure if I bill both e/m codes or what is the correct procedure for this situation. Any advise would be greatly appreciated.

  9. #19
    Join Date
    Apr 2007
    Columbia, MO


    you cannot bill two visits either you must combine both and bill it as a shared encounter. Per CR 1776.

    Debra A. Mitchell, MSPH, CPC-H

  10. #20

    Default who to bill under

    Hello, I understand the process of combining documentation from same specialty E/M visits on the same day to make one E/M visit. Does anyone know if there is documentation out there that states which MD/PA etc. to bill under or is that decided internally?

Page 2 of 3 FirstFirst 123 LastLast

Similar Threads

  1. Office visits not being paid same day as Mohs
    By debneas in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 04-15-2014, 09:55 AM
  2. Replies: 2
    Last Post: 09-15-2010, 01:57 PM
  3. Billing 2 office visits on the same day
    By adspann in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 09-14-2010, 01:00 PM
  4. Billing 2 office visits on the same day
    By adspann in forum Family Practice
    Replies: 2
    Last Post: 09-14-2010, 12:24 PM
  5. Modifiers for 2 office visits same day
    By JSimpson in forum E/M
    Replies: 4
    Last Post: 12-22-2009, 02:31 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.