Neurosurgery Coding Alert

Question: Sometimes patients see two of our physicians on the same day. Is it ever appropriate to report an E/M service for both physicians?


Nebraska Subscriber

Answer: You can report two evaluation and management services for one patient on the same day, if the patient sees two of your physicians who have different specialties.

When two physicians in the same specialty and same practice see a patient on the same day, you may see denials if you try to report an E/M service for each. Payers limit your option to one E/M service per day per specialty in the same group practice. If two neurosurgeons in the same group with different specialties see a patient on the same day, however, you should be compensated for both services.

Example: A patient sees your practice's spine surgeon for cervical instability (723.8, Other syndromes affecting cervical region) and pain (723.1, Cervicalgia, pain in neck) after a fall and then sees one of your neurosurgeons for assessment of possible meningioma. Because the physicians have different sub-specialties, go ahead and report both services. Assign a diagnosis code for the second service based on what the physician finds--for example, V10.86 (Personal history of malignant neoplasm of other parts of nervous system) plus V15.88 (History of fall).

Tip: Your payers may reimburse on just one of the E/M services because they don't often recognize physician sub-specialties (e.g., like cranial and spinal neurosurgeons). You can then appeal the denial. Submit documentation for both services, showing that two different neurosurgeons performed the services, and explain the difference in the physicians- expertise.