# Multiple complaints on same visit



## april j  (Feb 2, 2010)

An established patient wants an office visit to evaluate bilateral hand pain and bilateral knee pain. The biller insists that the office can see the patient for only one issue per day or the office will not get paid. Is this correct? I thought that the services would be diagnosis-related and separately payable for x rays, etc.


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## RebeccaWoodward* (Feb 2, 2010)

*That is simply incorrect*. Ask for her reference...


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## april j  (Feb 2, 2010)

> That is simply incorrect


Thank you. I have billed this type of multiple complaint visit for other specialties without a problem. I've been doing this for 30+ years, but newly certified and not as confident as I ought to be regarding orthopedic billing.


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## RebeccaWoodward* (Feb 2, 2010)

Your years of experience speaks for itself.  What was the biller recommending? For the patient to make a separate appointment for the other complaint?


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## april j  (Feb 2, 2010)

> a separate appointment for the other complaint?



Yes, and of course, my first instinct is that it's a ploy to have the patient come back multiple times. I am going to speak to the billing manager on behalf of the patient, who happens to be 93 years old and not inclined to making additional unnecessary trips to the doctor.


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## LLovett (Feb 2, 2010)

Just to play devils advocate for a minute.

The doctor can only do 1 office visit per day, doesn't matter how many issues are discussed.

I say this only because I responded to a post the other day where the provider was charging a consult and a preventive for the same visit. Which obviously would be incorrect.

Laura, CPC, CPMA, CEMC


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## mitchellde (Feb 2, 2010)

also how is the physician to get a complete picture if he does not address all the complaints at the same encounter.  In this example have bilateral hand and knee pain might not be just as simple as arthritis but could be a neurological issue.  To state to the physician that he can address only one complaint per encounter is just wrong and I can not imagine the physician going along with it.


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## RebeccaWoodward* (Feb 2, 2010)

That's exactly what I recommend!  That is very dangerous advice for your biller to be giving out. Medicare would not take those recommendations lightly.  Not only are these unnecessary trips but this could also be viewed as fraud.  If Medicare becomes suspect of a pattern or perhaps a whistle blower, Medicare will start looking for medical necessity.  There are instances where one of our ortho physicians may refer their patient to our hand surgeon for severe hand pain (possible CTS).  Medical necessity has been established.  However, re-scheduling patients for additional complaints has the appearance of one goal...monetary benefit...

Good Luck to you!


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## april j  (Feb 2, 2010)

Thank you for your answers. Turns out that this is an office policy, to treat only one "area" at a time. I spoke to the physician directly and he was pretty surprised to hear what I had to say. He asked me a few coding questions in this regard and I think the policy is going to change.


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