Wiki 2 Unrelated E/M performed on same day

[buuvaneisswaran]

It is an urgent care office visit coding.We have a patient who had come for 2 visit on same day with 10 minutes in between time for E/M for two different conditions to the same doctor .First he had come for injury with Workman compensation Insurance as Primary.After 10 minutes the patient arrived for Sinusitis and got Flu immunization with HMSA as primary insurance.Both visit has E/M.

we shouldn't code 2 E/M on same day and also my confusion is that since we bill to two different Insurance we could bill both the E/M codes for the Patient.Please help me..

 

[mitchellde]

If this were both to the same payer you would add the complexities of both together and bill one claim and one visit level. However you have two completely different types of payers and two different types of encounters. When this occurs and one is work comp then you submit a claim to work comp for that encounter and submit a claim to the commercial for its encounter. You will need to have two different encounters documented to be able to do this. No modifiers will be needed. Use only those dx codes that go with the specific encounter.

 

[buuvaneisswaran]

Buuvaneisswaran

Thank u.