EM Coding Alert

Question: I have a provider who would like to see new patients over the course of three separate days:

• Day 1, video visit: They would meet with the patient by video and obtain the patient’s history.
• Day 2, in-person visit: They would perform a physical exam.
• Day 3, video visit: Discuss the assessment and plan.

Would we need to drop charges for each of those visits if they were on separate days?

New Jersey Subscriber

Answer: Technically, you would — but you have a problem.

First, day 2’s visit does not meet the requirements of a billable evaluation and management (E/M) service, as it is only an exam and not inclusive of the other elements required. Repeating what was already done on day 1 would be a risky thing to do, as it’s not medically necessary to do so.

Day 1’s visit would have to be billed by time alone.

You would have to report day 3’s visit by either time or medical decision making (MDM) alone.

Red flag: You cannot combine the work of two different days, only the work performed on the same date of service. You may have to forgo payment for the exam per any current guidelines. Payers will also flag your claims and documentation when you’re billing three days in a row.