Wiki Billing to E/M visits on same DOS

[kcouncil]

Medical Coding Books

Good Afternoon

This is the scenario...

A patient came in for an INR check with the nurse in the morning. The medication needed to be adjusted so the NP billed the visit with a 99212 and 85610. Later that afternoon the patient came back to see a different provider for hip pain. That visit was billed with 99212. How would I bill these two office visits? They were completed on the same day but for non-related reasons.

Thank you all for your responses!

 

[madsmacpc]

I am assuming this patient is being seen by the same practice ? Only one E/M can be billed on same day. Regardless of new problem

 

[ellzeycoding]

I am assuming this patient is being seen by the same practice ? Only one E/M can be billed on same day. Regardless of new problem

that's not necessarily true.

Established patient E/M visits 99212-99214 have an MUE of 2 meaning that more these established E/M codes can be billed up to two times per day for CMS.

In the above scenario, it's possible to bill both services. You would add modifier 25 on the separate E/M service. Most likely you would have to send in notes or appeal.

But two separate problems on the same DOS for two separate encounters is possible under the right circumstances.

See this article..

http://blog.context4healthcare.com/compliance-edge/mue-allows-2-e/m-codes-billed-same-day-10-01-14