Can You Bill Multiple E/M Visits in Same Day for Same Patient?

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(No Transcript)
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Can You Bill Multiple E/M Visits in Same Day for
Same Patient?
Multiple EM visits on the same day for the same
patient addresses those instances when a single
code is reported by a physician(s) or other
qualified health care professional(s) for
multiple medical and/or Evaluation and Management
(E/M) services for a patient on a single date of
service. General E/M Code Procedure Generally,
a single E/M code should be used to report all
services provided for a patient on each given
day. But in some cases, a provider may perform
more than one office or outpatient E/M service
for a patient on the same day. New patient E/M
codes 99202- 99205 and established patient E/M
codes 99211-99215 dont state per day in their
descriptors, but payer rules may prevent you from
reporting more than one E/M code for a single
patient on the same date of service.
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Can You Bill Multiple E/M Visits in Same Day for
Same Patient?

• For reference, we shared The Medicare Claims
  Processing Manual, chapter 12, section 30.6.7.B
  i.e., office/outpatient E/M visits provided on
  the same day for unrelated problems.
• Strategies for Resolving Legacy AR in Orthopedic
  Practices
•  
• The para states that as for all other E/M
  services except where specifically noted, the
  Medicare Administrative Contractors (MACs) may
  not pay two E/M office visits billed by a
  physician (or physician of the same specialty
  from the same group practice) for the same
  beneficiary on the same day unless the physician
  documents that the visits were for unrelated
  problems in the office, off the campus-outpatient
  hospital, or on campus-outpatient hospital
  setting which could not be provided during the
  same encounter (e.g., an office visit for blood
  pressure medication evaluation, followed five
  hours later by a visit for evaluation of leg pain
  following an accident).
• To support reporting the services separately, you
  have to maintain distinct documentation for each
  service. You also will need to check payer
  preference for which modifier to append to the
  additional E/M code, such as modifier 25 or
  modifier 59. 

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Can You Bill Multiple E/M Visits in Same Day for
Same Patient?

• If a provider sees the patient twice on the same
  day for related problems and the payer doesnt
  allow you to report those services separately,
  then you should combine the work performed for
  the two visits and select a single E/M service
  code that best describes the combined service.
• For example, if a patient comes in with elevated
  blood pressure, the physician may give the
  patient medication and then have her come back
  later that day to see how she is doing. In this
  case, because the visits are for the same
  complaint, you should combine the work performed
  for the two visits into a single E/M code. 
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  Healthcare Billing
• Related Terminologies
• Same group physician and/or other qualified
  health care professional All physicians and/or
  other qualified health care professionals of the
  same group reporting the same Federal Tax
  Identification number.
• Same specialty physician or other qualified
  health care professional Physicians and/or other
  qualified health care professionals of the same
  group and same specialty reporting the same
  Federal Tax Identification number.

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Can You Bill Multiple E/M Visits in Same Day for
Same Patient?

• Modifier 25 Significant, separately identifiable
  evaluation and management service by the same
  physician or other qualified health care
  professional on the same day of the procedure or
  other service.
• Modifier 59 (Distinct Procedural Service) Under
  certain circumstances, it may be necessary to
  indicate that a procedure or service was distinct
  or independent from other non-E/M services
  performed on the same day. Modifier 59 is used to
  identify procedures/services, other than E/M
  services, that are not normally reported together
  but are appropriate under the circumstances. 
• Medical Billers and Coders (MBC) is a leading
  medical billing company providing complete
  revenue cycle solutions. We provide medical
  billing and coding services to practices of
  various medical specialties.
• Our reliable and accurate medical billing and
  coding services help your practice to receive
  accurate reimbursements. To learn more about our
  services, email us at info_at_medicalbillersandcoder
  s.com or call us at 888-357-3226 
• CPT Copyright American Medical Association. All
  rights reserved. CPT is a registered trademark
  of the American Medical Association (AMA)

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Can You Bill Multiple E/M Visits in Same Day for
Same Patient?

• References
• Medicare Claims Processing Manual, chapter 12
• Medical Economics March 2021 E/M coding Can you
  bill multiple same-day visits? 
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• FAQs
• 1. Can you bill 2 EM codes same day?
• Yes, in some cases, you can bill two EM
  (Evaluation and Management) codes for the same
  patient on the same day, but it depends on payer
  rules and documentation requirements.
• 2. What is the modifier for 2 visits same day?
• The modifier commonly used for reporting two EM
  visits on the same day is modifier 25. It
  signifies a significant, separately identifiable
  EM service provided by the same healthcare
  professional on the same day.

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Can You Bill Multiple E/M Visits in Same Day for
Same Patient?
3. Can 2 EM codes be billed together? Yes, two
EM codes can be billed together if the services
provided meet the necessary criteria for each
code and are supported by appropriate
documentation. 4. What are the EM codes for
outpatient visits? EM codes for outpatient
visits include New patient EM codes
99202-99205 Established patient EM codes
99211-99215 5. What are EM guidelines? EM
guidelines are criteria established by payers and
professional organizations to ensure accurate
reporting and reimbursement for Evaluation and
Management services. These guidelines typically
include documentation requirements, coding rules,
and criteria for selecting the appropriate EM
code based on the complexity and nature of the
patient encounter.