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Thread: multiple E/M

  1. #1

    Default multiple E/M

    AAPC: Back to School
    I work in a hospital outpatient department. The clinic and infusion site are in the same building, however the clinic operates under two umbrellas-hospital and their main clinic. The infusion side is hospital.
    My scenario is this...have a patient who is seen in the clinic by one physician, the patient is then sent over to the infusion side to receive chemo, has a reaction, and then the NP is called over by one of the infusion nurses to evaluate. Both the doctor and NP documented their visits with the patient. I have been informed we are unable to charge two clinic visits on the same day, but I feel we are missing charges in situations such as this.

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    The outpatient facility may indeed charge mutiple E&M encounters on the same day, you will need a 27 modifier on the second and subsequent E&M and if you have more than one in the same revenue center on the same day then you nned a G0 condition code. also if one E&M needs a 25 modifier then they all need a 25 modifier regardless of where the procedure was performed, so if you do infusions then all E&Ms on the claim need a 25 modifier and the second and subsequent will need a 27 as well.
    Do not confuse physician billing with facility on this issue as the rules and dos and don'ts are different.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Default 2 Office encounters

    Each provider would have to document their time (not necessarily based on counseling and coordinationof care.....just a time statement). Then the time can be combined and one of them can bill with a prolonged service code if the total time is greater than 30 minutes of the level billed.
    Otherwise you're out.

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