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j_warman

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Is it appropriate to bill a 99203 and 99204 on the same bill for the same date of service/same visit for the same reason? Patient was seen at an Urgent care by the DR and the nurse did assist but there was only one reasoning of the patient being seen.
 
I don't think so

I am sure you cannot bill 2 E/Ms for the same date of service in the same location for the same dx.
 
I don't think so

I am sure you cannot bill 2 E/Ms for the same date of service in the same location for the same Dx.
 
There is no reason I can think of where this would be appropriate. Perhaps you could elaborate on the circumstances. You have not indicated tha two new patient encounters occurred which makes me curious as to why you think 2 new patient levels for what appears to be the same visit are appropriate.
 
Both of these codes are for new patient office services. A patient can only be "new" to that practice one time. If the patient was seen, left and returned for the same reason on the same day, you would choose an established patient E/M code. IMO

The only time I can think of where you might be able to bill 2 "new" patient visits on the same day is if one was with a general practioner and the other was with a specialist.

CPT guidelines state "A new patient is one who has not received any professional services from the physician/qualified health care professional or other physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
 
I personally didn't think that it was appropriate to bill 2 e/m's but another coder in my office is stating that I can/should since the DR saw the patient and the nurse. I looked through the CPT book and could not find anything stating that I could charge 2 e/m's. There was only 1 dx and only 1 encounter for this patient.
 
j_warman said:
I personally didn't think that it was appropriate to bill 2 e/m's but another coder in my office is stating that I can/should since the DR saw the patient and the nurse. I looked through the CPT book and could not find anything stating that I could charge 2 e/m's. There was only 1 dx and only 1 encounter for this patient.
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You are right...this is not correct billing. I would request your coder to produce proof of his/her recommendation. It would be interesting to see what they come up with...
 
If you're billing for both the professional and facility sides of the visit, then you would have two E&M codes. The professional one is assigned based on E&M documentation guidelines. The facility one is assigned based on the facility matrix for resource consumption. If this was a new patient both to the provider and the facility, then you could very well have a 99203 and 99204. One would be billed out on 1500 and the other on a UB-04.
 
Yes that is correct, the poster did not specify that this was the case but if the coworkers are insisting that there be 2 then perhaps it is hospital based, it would clear things up alot to know.
 
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