Oncology & Hematology Coding Alert

Question: Can we bill two office visits on the same day? We reported 99214 twice for the same date of service but used different diagnoses. Insurance paid one and denied the other.

Tennessee Subscriber

Answer: Most insurers will not allow you to report two E/M services on the same date. These payers base their regulations on Medicare rules, which prohibit you from billing these together (with limited exceptions noted below).

According to MLN Matters article MM4032, "Carriers may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident)." You can read this article at www.cms.gov/mlnmattersarticles/downloads/MM4032.pdf.

As a result, unless you meet the specified exceptions, you should base your code choice on the combined documentation for both encounters.

Private payers may follow this rule, or they may make their own payment guidelines. Search out payer-specific guidelines on this topic, and alert your physician to the reporting rules.