Get the Truth About Multiple, Same-Day E/M Services
Published on Tue Feb 07, 2006
With effort, you can get payment for unrelated problems If a patient visits your office twice on the same day, you may be able to report two separate E/M services, but you-ll have to put forth additional effort if you expect the payer to recognize your claim.
Myth: Many coders believe that you can't bill Medicare for more than one E/M visit on the same day, and that you should combine two or more visits into one. Indeed, Medicare transmittal 1644 (August 1999) specifies, -Pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not.-
Reality: Although the above rule holds true for the hospital, payers will allow for exceptions in the office setting, experts say. You may report multiple in-office E/Ms on the same day -- but it can be an uphill battle.
Unrelated problems are key: Medicare will pay for two office visits by the same physician for the same patient on the same day if the visits are for unrelated problems, according to the Medicare Claims Processing Manual.
Example: The patient arrives early in the day with pain in the lower abdomen. The surgeon examines the patient, diagnoses a hernia (for example, 550.9x, Inguinal hernia, without mention of obstruction or gangrene) and recommends surgery.
Several hours later, the patient's wife brings him back to the surgeon's office, stating that while shopping nearby the patient tripped and hurt his ankle severely and now cannot walk. The surgeon sees the patient in the office on an -emergency- basis and performs a second E/M related to the new complaint.
In this case, the surgeon sees the same patient twice on the same day for unrelated problems. At each visit the surgeon has to provide a complete evaluation. Such cases are rare, but when they arise, you could be justified in reporting two separate E/M services.
Important exception: Whenever the E/M code descriptor specifically lists -per day- (for instance, 99218, Initial observation care, per day, for the evaluation and management of a patient ...), you must include all E/M services for that date in the service no matter how different the diagnoses. Bulletproof Your Documentation Chances are, your carrier will deny claims for two E/M visits on the same day, says Phyllis Klein, president of PK Administrative Services in Englewood, Colo. Unless the physician needs to use a critical care code (99291-99296) in the office or reports prolonged care (99354-99357) in addition to the E/M code, the carrier probably won't know what to make of it, Klein says.
Ask yourself if it's worthwhile: -You-re going to have to send documentation, you-re going to have your payments delayed, and the patient's going to have [...]
