ED Coding and Reimbursement Alert

Question: Does anyone know a successful way to get Medicare to pay for two ED visits on the same day for different diagnoses? I am unsure if modifier 77 would work at this point. Has anyone been successful recently?

Virginia Subscriber

Answer: Historically, it was thought that multiple office visits or Emergency Department visits in a single day should be combined and one single E/M should be billed under all circumstances.

For multiple ED visits in a single day, CPT® Information Services has offered some guidance:

"From a CPT® coding perspective, if a physician performs an E/M service for a patient who returns that same day for an additional E/M service, then both E/M services may be reported based upon the key components (i.e., history, examination, medical decision making) performed. Modifier 59 (Distinct Procedural Service), should be appended to the second E/M code to indicate that it was performed at a separate encounter." CPT® coding guidelines do not limit the number of Office or Other Outpatient Evaluation and Management (E/M) service codes that a physician may report on the same date of service.

Note that the AMA's official instructions are to use the 59 modifier rather than the 25 modifier.

The 77 modifier (Repeat procedure or service by another physician or qualified health care professional) would not be the best choice for capturing two E/M visits. As this is an area of variability in policy, make sure to check with your carrier for direction.