# coding visit for 2 different problems, 2 different ins



## ilenefla (Aug 19, 2011)

We are a pain management practice.  We have many patients who are here due to work or motor vehicle accidents.  Sometimes these same patients develop another issue that is not related to the work or mva and we treat them for that also.  We have the dr create 2 medical notes and he does a workup for each individual issue.   We then bill each ins appropriately.  

Is this the correct way to handle this?  Or do we need to inconvenience the patient and make them come to the office on 2 separate days for each individual problem.


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## btadlock1 (Aug 19, 2011)

ilenefla said:


> We are a pain management practice.  We have many patients who are here due to work or motor vehicle accidents.  Sometimes these same patients develop another issue that is not related to the work or mva and we treat them for that also.  We have the dr create 2 medical notes and he does a workup for each individual issue.   We then bill each ins appropriately.
> 
> Is this the correct way to handle this?  Or do we need to inconvenience the patient and make them come to the office on 2 separate days for each individual problem.



I'd keep doing it the way that you are - there's no sense in making them come back another day for their separate problem, but you definitely don't want to mix up the encounter notes; I've tried to untangle a mess like that before (commercial payor denying services for a sick visit, because the provider was also treating for a W/C injury, and of course, W/C won't cover a regular sick visit that doesn't pertain to the injury) - it was kind of a nightmare. It would get documented the same way whether you made both notes at the same time, or if you made the patient come back later on for the second issue, so I don't see why it would be a problem.


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## dwaldman (Aug 23, 2011)

99 percent of the time the accident caused excerbation of previous conditions and/or created new conditions and it is very difficult to tell what is related and what is not and the claims are billed to the auto carrier/liability and held 120 days from the DOS before billing Medicare conditionally. 
I would look up MSP on the CMS site before instructing the doctor to create two notes.


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