Pediatric Coding Alert

Question: If a patient comes in twice in one day because he feels worse later on in the day, are we allowed to collect a second copay at the second visit? Most insurers only allow you to bill an E/M code once per day, but if we are doing labs during the second visit, we can bill for those. I’m unsure if a copay is applicable.

Codify Subscriber

Answer: No, your managed care contract probably restricts you from reporting two copays during the same date of service. Instead, you should combine the visits if the patient sees the same doctor both times, and collect just one copay.

Caveat: If the patient sees Dr. A in the morning and Dr. B in the afternoon, then you can bill both visits. More than likely, the payer will reject the second one—however, the new modifiers put out by CMS (the “X” modifiers) would allow billing for both. You’ll bill the first code normally, and the second one with modifier XP (Second service on same day by a different provider) appended.