General Surgery Coding Alert

Question: We had a patient with a hiatal hernia who saw one surgeon in our practice, and the surgeon asked that the patient see a different surgeon in our the practice due to some complicating factors in his case. Can we bill E/M services for both surgeons on the same day?

Missouri Subscriber

Answer: No, you cannot bill two separate codes for the same-patient, same-day services. You would normally combine both E/M services into one code. CPT® considers an E/M service's history and physical global for the day. Therefore, correct billing bundles same-day office visits together.

Let's say the patient is established in the practice and first surgeon's documentation supports 99213 (Office or other outpatient visit ...) while the second surgeon documents 99214. If you submit 99213 and 99214 on the same day, the payer will reject one of the E/M services -- usually the higher-paying office visit -- as duplicate charges.

Better way: Combine the two physicians' work and submit one E/M code, such as 99215 if it's justified by the documentation.

If the surgeons are in two different groups (not covering for each other), they should each bill the appropriate E/M service code. But insurers may still require different ICD-9 diagnoses before they'll pay for two services.