Wiki Telemedicine visit & Office visit - same day - separate issues

mmiele1979

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I'm not sure how to bill for this. Patient had a scheduled med check via telehealth with his primary care physician. On this call he mentioned that during basketball tryouts the evening before, he injured his leg. The provider advised him to come on in if it was still bothering him and proceeded with the med check. Later that afternoon, patient came in to get his leg looked at. How do I bill these completely separate incidents that occurred on the same day?
 
I personally would likely bundle the care provided into 1 E/M. If the patient didn't have the telehealth in the morning, he would not have had the in-person office visit in the afternoon.

You indicate "call" in your post. If by call, you mean this was an audio only telephone call, then it's definitely not separately billable.
99441-99443 specify do not originate from a related E/M service within the previous seven days and do not lead to an E/M service or procedure within the next 24 hours or soonest available appointment. In that case, the telephone call, although started for a different issue, did lead to an E/M service within 24 hours or soonest available. To me, this is clearly 1 E/M service with all work being counted.

If by "call" you mean a video interaction billed with E/M, it's more of a gray area.
CMS specifies 2 E/M services by same physician (or physician group of same specialty), same day, is not separately billable unless it is for 2 unrelated problems. I would have to check references, but I believe CMS specifies modifier -25 in that situation.
Many commercial carriers will set their own rules about this and may not allow 2 E/M visits, even if for different reasons.
Since the provider & patient discussed his leg in the morning (some HPI elements are there), and the provider made a very brief assessment, I personally would not feel comfortable billing 2 separate E/M, and would bundle all work into 1 E/M.

Hope that helps!
 
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