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Reader Question: Repeat, Same-Day ER Visits

Question: How should we code for two ER visits on the same day? Patients often come into our care center two, three or even more times during a single day.

Florida Subscriber

Answer: Billing depends on whether these visits are for different issues, or whether they represent an exacerbation of a condition, requiring more intensive care. If you have a separate, identifiable service each time, you can include the appropriate E/M code with each service code. Otherwise, both E/M services would likely be bundled to the service rendered earlier in the day. If a patient is returning for the same service, such as repeated IV antibiotics for cellulitis, only one E/M should be reported. However, for condition changes, such as worsening symptoms or the need for a completely new evaluation, you would use a second E/M code with a G0 condition code attached.

For example, a patient comes in early in the day with a cut on his or her neck, which is repaired with a simple closure. Report 12001 (simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) accompanied by a low-level E/M code. If the patient returns six hours later with the stitches torn out and the laceration requiring a more extensive closure, use the highest E/M code possible based on the amount of work performed during the visit. Support the code with evidence of high-level decision-making and appropriate documentation. The second incident requires a more complex service code for the closure, such as 12042 (layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm) plus the higher-level E/M code to indicate the greater amount of work required.

As of Oct. 1, 2001, facilities would use modifier -27 (multiple outpatient hospital E/M encounters on the same date) to differentiate between visits made to the same facility on the same day. This is to avoid mistaking repeat visits as a facility error or as an attempt to double-bill Medicare. This code does not replace the G0 condition code.

- Published on 2001-10-01

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