Wiki Clinic and ER visit; same day, same physician, same diagnosis

[mworm2018]

I work in a clinic that is attached to our town hospital and our doctors are the ones that report to ER to see patients that arrive there. We bill out for our doctors services from our clinic. I had a patient that was seen in ER at midnight and saw one of our physicians. We had coded out 99283. However, patient was asked to follow up in clinic later that same day. Patient came to our clinic and was seen by same physician for same problem. Can 99213 be billed or does this have to be a no charge since it was same day, same provider, same diagnosis? It would be same tax ID number along with same NPI number.

 

[thomas7331]

In my experience, most payers have policies in place that will only allow for one E&M service per provider per day unless the patient is returning for a completely new and unrelated problem. Even with unrelated problems, though, these can be very difficult to get paid and often require an appeal. You may wish to confirm this with your payer, but the standard practice is to combine all E&M services by a given provider on the same date into a single CPT code.