Case Study: 1 Clever Rule Nets You Almost $230 for Repeat Asthmatic

Learn how to combine encounters to optimize your group practice pay
You can ethically maximize reimbursement for yourself and your partner(s) when you treat an asthma patient on the same day if you combine your E/M services and nebulizer-related procedures.
When allergists in the same group practice perform a service and procedure on the same day, you may be tempted to bill separate claims. But this coding method will cost you E/M and procedure pay, as the following case study shows:
Test Your Dual-Encounter Coding
In allergy group practices, you file claims under one tax identification number. So, if you have multiple same-day claims for a patient, the insurer won't recognize that different allergists performed the charges. That means the payer will reject the same-day E/M and possibly deny additional procedures as duplicative, says Susan Callaway, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.
Solution: Treat the allergists'services and procedures as one.
Challenge: See if you can combine multiple same-day services and procedures for an asthma patient who requires repeat nebulizer treatments. In the following real-world case, both allergists are in the same group and file claims under the same tax identification number.

The case: Amother brings her child who is having an asthma attack into your office at 9 a.m. for a sick appointment. Allergist Atreats the child with two nebulizer treatments and an injection. He spends 50 minutes face-to-face with the child, not including time spent performing the procedures. He codes the visit as 99214 and marks appropriate nebulizations, medications and injection codes.

At 4:10 p.m., the mother returns as a walk-in with the child, who is now wheezing and in distress. Allergist Ahas left for the day, so Allergist B sees the child and administers two nebulizer treatments with medications and an injection. He also calls emergency medical services to transport the child to the emergency department. He spends 70 face-to-face minutes with the patient, not including procedures.
Combine Direct E/M Time
When two allergists in the same group treat a repeat asthmatic, you may not know how to report the day's services. In such situations, "What is the appropriate way to code for each physician's work for maximum reimbursement?" asks Kathy Wilborn, practice manager at Cook Children's Physician Network - Hurst Clinic in Hurst, Texas.
Hint: Don't treat each allergist in the above scenario as an individual.
If you bill an office visit for each allergist, the insurer will reject the second E/M as a duplicate service. To avoid a denial, one coder suggests billing 99214 for Allergist Aand no E/M for Allergist B. But coding only one physician's services will cost [...]

- Published on 2004-06-07