Wiki Telehealth & E/M visit same day...

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tgiunta

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Scenario: A patient received a telehealth visit with provider #1 and subsequently was referred to the office for a face to face visit with Dr #2 (separate doctors / same group practice). Would it be appropriate to bill for two separate charges since this is two different providers? I normally bill only for the face to face visit but could not locate specific guidelines to support my rationale. This is a current hot topic among the providers in my office and I would love any/all feedback :).
 
Are the providers the same specialty? If they are the same specialty and the patient is being seen for the same problem at each visit, the visits will need to be combined and one level of service billed. Per the Medicare Claims Processing Manual, Chapter 12, Section 30.6.5, "If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level." https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
 
Hi there, sorry could you clarify - are the physicians the same specialty and what did the second physician do? Was it another E/M visit or a procedure? Basically I would treat this as two in-person visits on the same day and code accordingly.
 
jkyles@decisionhealth.com said:
Hi there, sorry could you clarify - are the physicians the same specialty and what did the second physician do? Was it another E/M visit or a procedure? Basically I would treat this as two in-person visits on the same day and code accordingly.
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The physicians are both PCP (same specialty) and both visits were for the same problem.
 
tgiunta said:
The physicians are both PCP (same specialty) and both visits were for the same problem.
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Got it. A Briggs is correct.

It might help to remind your doctors that the underlying rules for coding and billing claims still apply to services performed by telehealth.
 
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