# Being seen twice in the ED on the same day



## jenniferg30 (Jul 29, 2009)

We have been having multiple "discussions" on how to code for a patient who has been seen twice in the ED, and everytime I turn around I'm getting  different directions from different people in the office.  Sometimes the patient will be treated by the same physician on the second visit of the day and sometimes they will be treated by a different ED physician.  Sometimes the patient will also be seen for the same diagnosis.  At first we were voiding out the second visit and increasing the E/M on the first visit (ex: making the code a 99284 or a 99285 instead of a 99283).   Then I was told to quit doing that and start using the modifier 27 on the second visit.  Has anyone else came across this situation and how did you handle it?


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## ahinman (Jul 29, 2009)

We charge for both visits individually and append a modifier to the second visit.


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## mitchellde (Jul 30, 2009)

jenniferg30 said:


> We have been having multiple "discussions" on how to code for a patient who has been seen twice in the ED, and everytime I turn around I'm getting  different directions from different people in the office.  Sometimes the patient will be treated by the same physician on the second visit of the day and sometimes they will be treated by a different ED physician.  Sometimes the patient will also be seen for the same diagnosis.  At first we were voiding out the second visit and increasing the E/M on the first visit (ex: making the code a 99284 or a 99285 instead of a 99283).   Then I was told to quit doing that and start using the modifier 27 on the second visit.  Has anyone else came across this situation and how did you handle it?



Are coding for the facility or the physician?  I ask because the 27 modifier is a facility only modifier. If you code for the facility then you should code each visit and append the 27 modifier, also a G0 condition code will be required for two visits on the same day in the same rev center.


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## debarr (Sep 14, 2009)

*still question????*

But what about the physician charge?  Going out on a 1500 claim....is there a modifer you use or if they were seen for the same thing on the same day by the same er doc -i always thought you should have combined the two charts and put one level on for the day??????? please help


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## jimbo1231 (Sep 14, 2009)

*Medicare*

You do have to combine both vists for Medicare for physician code. For other payors you can code separately with 25 modifier. But I would check with major payors on it.

Jim


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