I would say combine the documentation and bill for one visit if it was the same issue. However per Medicare e/m manual you can add 76 modifier:
"76 Modifier Repeat procedure by same physician: use to indicate that a procedure or service was repeated subsequent to the original service
Use the 76 modifier when billing for separate office or outpatient E/M visits that occur on the same date of service (only for codes 99211â€“99215) by the same physician/practitioner.
Each service should be clearly documented.
Use the 76 modifier to indicate a separate encounter occurred on the same date of service when separate services are billed. Do not use the 76 modifier for the initial visit.
Example of Proper Usage
A patient visits the physician on Wednesday morning for a bladder infection. She is treated and sent home. That same afternoon, the patient returns to the physicianâ€™s office with a twisted ankle. Each service should be reported with the appropriate level of E/M service with the 76 modifier added to the second visit for the twisted ankle."
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