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2 office visits on same day

  1. Default 2 office visits on same day
    Medical Coding Books
    Physician does a new patient visit and he calls for a stat CT and patient comes back again in the afternoon after the CT scan and he does another and established office visit. What is the critieria can he bill for two office visits on the same day and we have documentation that he has performed each one of them.

  2. #2
    Default
    I am assuming that this was for the same problem and therefore same diagnosis. In this case, I don't think you should bill for two visits. You should bill one E/M code based on the "bullets" that were documented in both visits. You may want to consider the "prolonged care" code if the additional services provided qualify.

    Holly M.

  3. Default
    The general rule of thumb is that there can only be one E/M code per day. Per the CPT manual, "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."

    So, combine the two services together, which may result in a higher level new pt visit or if the two services together were extensive, you may be able to use the prolonged service code(s). Hopes this helps.

  4. #4
    Location
    St. Louis, Missouri
    Posts
    262
    Default
    You can only code one e&m per day. Just use documentation for both of the visits to come up with the e&m level.

    Melissa Blow, CPC

  5. #5
    Default Documentation is key
    If you have separate documentation for both visits, I'd bill both and append modifier 25 to the second.

    That being said, I assume you will have separate diagnoses. The first should be for the symptoms prompting the CT, the second should be the definitive diagnosis as a result of the CT.

    You should bill these claims together, on a paper claim form, with a brief explanation of the separateness and documentation of both encounters attached. You may have to appeal a decision to rebundle the claims, but you should win if you try. You may want to direct the claims to your provider representative right off the bat if they are willling to accept it; they can be very helpful in these rare, sticky situations.
    Belinda S. Frisch, CPC, CEMC
    Author of "Correct Coding for Medicare, Compliance, and Reimbursement"

  6. #6
    Default
    I do not agree with the 25 modifier solution. You should combine the documentation and see what new patient office visit level of service the documentation supports.

  7. Default
    Quote Originally Posted by jasherman View Post
    I do not agree with the 25 modifier solution. You should combine the documentation and see what new patient office visit level of service the documentation supports.

    I agree. Documentation should be counted from both visits and coded as one visit.
    ~Amy, CPC, CPMA, CEMC~
    Auditor/Consultant

  8. #8
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    I believe that the only way a modifier -25 could be reported is if the problem for the second visit was COMPLETELY different from the first. In the case here, it is the same problem and should only be coded as one visit - the higher of the two documented visits.
    Lisa

  9. Default
    What about when a physician sees a patient and bills an E&M code and an occupational therapist also bills out an E&M code? Does anyone know how to code for that? 99211 and 99212 can also be used for clinic assessments for rehab services. My situation is that we have a physician that sees the patient and refers the patient to the OT on the same day in the physician;s clinic. The OT is not employed by the physician but employed by the hospital so that hospital would bill out the OT charges. The physician bills out their E&M code and then we bill out ours. Does anyone know how to code for that?

  10. Default
    Two different specialties, so if should not be an issue in my opinion

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