# Coding for 2 visits on the same day



## abill_423 (Aug 20, 2008)

I don't have much experience in E/M coding and need some help. If a physician sees a patient in the hospital and has to go back and see the patient again because there has been a change in their condition, can you bill for 2 visits on the same day? Or would you combine the two visits and bump up the charge from, for example, a 99231 to a 99233? 

Any guidance that you can provide is greatly appreciated.


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## RebeccaWoodward* (Aug 20, 2008)

You would combine the two visits and bill for the E/M level that supports the documentation...assuming that both visits were for the same diagnosis.


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## Lisa Bledsoe (Aug 20, 2008)

I agree with Rebecca.  However even if the diagnoses were different, only one inpatient hospital visit per physician per day is billable.


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## RebeccaWoodward* (Aug 20, 2008)

Now see...that's where Medicare kills me. (Even though we're not technically speaking about Medicare...most carriers follow their standards). I attended a Medicare workshop yesterday and this very scenerio was presented.  Per the Medicare rep (2 in fact) agreed that the second claim would deny.  The rule of thumb was to submit an appeal with documentation to support both visits and most times the second claim would be paid.  _NOW_...have I ever, personally, experienced this? No.  Do I believe their statement?  The verdict is still out.  Medicare's handy, little booklet that they provided yesterday upholds their statement.  If and when I have this scenerio, you better believe I will copy and mail this guideline with my appeal and documentation.


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## Lisa Bledsoe (Aug 20, 2008)

Talk about muddying the waters! That statement (from the Medicare "reps") definately goes against CPT guidelines (pg 12 Cpt Professional edition...for those with the standard edition this info is under the section for Inpatient Hospital Care).  Sorry, not up to quoting...too much typing involved p ).


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## RebeccaWoodward* (Aug 20, 2008)

Isn't that the truth!  You should have heard the statements about "incident to".  Everyone was in a state of shock.  Here's an example they gave:

-PA-not yet credentialed with Medicare
-Physician is in the office
-PA (that's not credentialed with Medicare,yet) see's the patient for a NEW problem-MD does not establish or become involved in the plan of treatment
-PA treats patient and files "incident to"

The reps stated that you _could_ file incident to and get paid; although, it's not technically correct and in the long run, you_ may_ be asked for a refund.      Talk about going against everything I've been taught.......


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## Lisa Bledsoe (Aug 20, 2008)

If I were you, I would contact your provider education dept for the carrier and let them know you were told contradictory information in that workshop.  Sounds to me like these "reps" (are they coders?) are not clear on the rules.  Just out of curiosity, who is your carrier?


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## abill_423 (Aug 20, 2008)

Thank you for your responses. I love these forums and appreciate that everyone wants to share their experiences.


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## coderchick (Aug 21, 2008)

*in reponse to Abill*



abill_423 said:


> Thank you for your responses. I love these forums and appreciate that everyone wants to share their experiences.



If you are billing medicare you can use "condition code G0" #0 to the second visit

G0 = Distinct Medical Visit 

Report this code when mutiple medical visits occured on same day in the same revenue center, but the visits were distinct, and constituted independent visits. An example is a beneficiary going to the emergency room twice on the same day, in the morning for a broken arm and later for chest pain 

This information can be found in the UB editor


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## geugene (Aug 21, 2008)

*Contributor*

The notes should be combined if they are by the same physician on the same day regardless of the dx. The physician can report only one subsequent visit for that day. Also, reps. delivering wrong information should be reported.


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## FTessaBartels (Aug 22, 2008)

*Does later visit qualify for critical care?*

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


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