Neurology & Pain Management Coding Alert

Question: A patient of ours was involved in an accident and came to our office for an E/M visit because of jaw pain. Our surgeon billed 99213 for the visit. The patient returned the next morning complaining of neck pain from the same accident. How should I code these visits, considering I can only report one E/M code -per day- and that our physician saw the patient twice within 24 hours?

Florida Subscriber

Answer: Rest easy with your coding dilemma. CPT's descriptions refer to E/M services -per day,- not per 24-hour period, so you can report separate codes for your physician's services.

The day starts at midnight and ends at 11:59:59 p.m. Although you can report only one inpatient E/M service per day, keep in mind that if you perform an initial hospital visit for a patient at 10 p.m. and submit hospital admission code 99222, the physician can still see the same patient at 7:30 the following morning and submit 99232 for subsequent hospital care.

The same coding principles apply to outpatient services, allowing you to bill separate services on different dates, assuming that the neurologist's documentation meets CPT's criteria to report the E/M visits on both dates. If so, submit each claim with 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...).