If the patient's condition has worsened to the point s/he is critically ill and the physician's second visit documentation shows s/he provided critical care (at least 30 minutes, face-to-face), then you might be able to bill the two visits distinctly. In this scenario, I'd add a -25 modifier to the first E/M.

Otherwise, I'd combine the documentation of the two visits to arrive at my subsequent hospital care level of service.

I deal exclusively in pediatrics, so don't have to tangle with Medicare ... but Medicaid follows basically the same guidelines. Be prepared to appeal.

F Tessa Bartels, CPC, CPC-E/M