Primary Care Coding Alert

Question: Early in the morning, the physician diagnosed a woman with acute bronchitis and hypertension, gave her a bronchodilator and sent her home. In the late afternoon, she returned with elevated blood pressure (higher than the morning visit) and a headache. The physician examined her again and found her to be normal, determining that her symptoms were probably a reaction to the bronchodilator. After she rested one hour in the office, her headache subsided and her blood pressure went down. Because the two visits were extensive, I want to bill for both. Will the claim be denied for billing two office visits in one day?

New Hampshire Subscriber

Answer: It is a common misconception that you cannot bill for two office visits in one day. While you cannot bill for more than one hospital visit per day because the visit codes are per-diem codes that does not apply to office visits. Bill for both office visits with the appropriate-level E/M code and append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the second visit.

A different diagnosis is not necessary for the second visit because you are attaching modifier -25. This modifier permits the second E/M service to be prompted by the symptom or condition that caused the first visit. Link the diagnosis codes for acute bronchitis (466.0) and hypertension (e.g., 401.1, Essential hypertension, benign) to both E/M codes.