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2 office visits on same day

  1. Default
    Medical Coding Books
    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. 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. Default
    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
    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. Default
    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. Default
    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. Default
    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. 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
    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. 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?

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