only in certain circumstances...
Hi there,
My experience is actually quite different - I believe that there are
few circumstances that allow you to bill 2 visits by the same specialty on the same DOS. i.e. I would not bill a 99283 and a 99284 on the same DOS for the same PT. My belief is that one E/M will be denied outside of certain situations.
We get denials from visits where the PT has been seen in another ED on the same DOS, and I do not believe that the denials are dx related.
An E/M and then Critical Care services on the same DOS are billable, in which case one would add a -25 modifier to the initial service.
If a patient has 2 visits on the same DOS in our ED, we accumulate the time and effort from both visits and bill one E/M. In the event that someone has identifiable visits with different carries (i.e. bronchitis at 8am, and then back pain from an MVA at 10am - and therefore health and then MVA insurance), we bill those separately. With procedures, a -76 or a -77 modifier may apply, but those are worth exploring on a case-by-case basis. In my experience, even if we had a patient come in once with sinusitis and then later with a broken wrist from a fall at home, we would not bill two separate E/Ms.
From the CMS website (and I think it can be applied for ED as well - I could not unfortunately find explicit language about "2 visits in the ED on the same DOS", though that is the same as "two visits in the same specialty" so...):
"The Medicare Claims Processing Manual (Chapter 12, Section 30.6.7), Paragraph B, clarifies “physician in a group practice” for office/outpatient E/M visits provided on the same day of unrelated problems, are as follows:
• As for all other E/M services except where specifically noted, 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)."
[from]
http://www.cms.hhs.gov/mlnmattersarticles/downloads/MM4032.pdf
Also, the discussion in the forum about critical care services and other E/M services on the same DOS may be helpful.
I hope this helps...sorry if a bit long-winded.
It would be great to see a reference either way (that it's explicitly ok in the ED, or not) - anyone have one?
would love to know.
good luck!