Neurology & Pain Management Coding Alert

Question: I had patients see two physicians on the same day. May I submit an E/M code for both physicians?

Nevada Subscriber

Answer: It depends on the physicians specialties. If two physicians in the same specialty and same practice see a patient on the same day, you will likely get denials if you report an E/M service for each provider .Most payers limit your options to one E/M service per day per specialty in the same group practice.

Exception: You may report two E/M services for one patient on the same day if the patient sees two of your physicians who have different specialties. If two physicians in the same multispecialty group with different specialties, such as neurology and cardiology, see a patient on the same day for diagnosis and/or treatment of different conditions, you should be compensated for both services.

Example: A patient sees her primary care provider, a family practitioner, in your group practice for lumbar instability (724.8, Other symptoms referable to back) and low back pain (724.2, Lumbago) after a fall V15.88 (History of fall) and then sees one of your neurologists for assessment of possible cubital tunnel syndrome. Since the physicians have different specialties, you may report both services. Assign a diagnosis code for the neurologists service based on what the physician finds or the patients signs and symptoms if no definitive diagnosis is established -- for instance, 354.2 (Lesion of ulnar nerve) or 782.0 (Disturbance of skin sensation).

Heads up: Your payers might reimburse on only one of the E/M services because their claims processing software doesnt have the capability to recognize the providers different specialties. Appeal the denial with documentation for both providers services, showing that two different specialties performed the services for different medical conditions, and explain the difference in the physicians expertise.