Wiki Return Visit Same Day Same Diagnosis

[courtneymarshall]

I bill for an Urgent Care Facility and we had a patient come in during the morning with a condition and was treated and left. He later returned back to the clinic for symptoms worsening and had additional work done. The provider that saw the patient in the afternoon added her work to the previous provider's paperwork and wanted to combine the documentation in order to code a higher E&M level. Is this allowed? If so does anyone know where I can find documentation to prove either way if this is acceptable or not?

 

[Naveen Rachagolla]

A. Two Hospital Visits Same Day

Contractors pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not. The inpatient hospital visit descriptors contain the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician should select a code that reflects all services provided during the date of the service.

B. Hospital Visits Same Day But by Different Physicians

In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering for A, sees the same patient in the evening, contractors do not pay physician B for the second visit. The hospital visit descriptors include the phrase “per day” meaning care for the day.
If the physicians are each responsible for a different aspect of the patient’s care, pay both visits if the physicians are in different specialties and the visits are billed with different diagnoses. There are circumstances where concurrent care may be billed by physicians of the same specialty.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2282CP.pdf