Wiki Two visits ED, same day MD patient

[rogers]

I have a situation where a MD patient came to the ED twice in the same day. Once early in the morning, once late in the evening. Both visits the patient was seen for the same thing, one visit had a more extensive workup than the second, and both times the patient left against medical advice. Because of the way the charts come to us, we were unable to determine the patient was being seen for the second time in a 24 hour period, so both visits were billed to MD. The lower level was paid, and the higher level bill is being denied. My question is this... since the patient left both times against the medical advice of the ED physician, can we legally bill the patient for the second visit that is getting denied? We do not want to write this off if it's possible to get payment.
Thanks in advance

 

[jimbo1231]

Same Day

On the physician side two visits on the same day tothe same physician for the same reason are usually combined for Medicare which is probably the reason one was was denied. Leaving AMA doesn't really factor in. You could argue that a higher level should have been paid based on combining both visits. But since both were billed not sure you have much of an argument. Sometimes the modifier 27 is used but that should be for the facility side.

Jim

 

[kevbshields]

Why aren't you combining the two notes into a single E/M level, on a single bill?