E/M coding: Can you bill multiple same-day visits? (2024)

July 6, 2021

Publication

Article

Q: Can a physician ever bill more than one office evaluation and management (E/M) code for a patient in the same day?

A: 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 don’t 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.

For instance, Medicare will “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,” according to the Medicare Claims Processing Manual, chapter 12, section 30.6.7.B.

There is, however, an exception to Medicare’s rule about reporting multiple office and outpatient E/M services on the same date. If the provider documents that the visits were for unrelated problems and that the services could not be provided during the same encounter, then Medicare allows you to report separate E/M codes for the same date. The example the Medicare manual provides is a patient presenting for blood pressure medication evaluation and then returning five hours later for evaluation of leg pain following an accident.

To support reporting the services separately, experts advise maintaining 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 (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) or modifier 59 (distinct procedural service).

If a provider sees the patient twice on the same day for related problems and the payer doesn’t 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.

As an expert in medical coding and billing practices, I have an in-depth understanding of the nuances and complexities involved in accurately documenting and reporting evaluation and management (E/M) services. My expertise is rooted in extensive knowledge of official coding guidelines, payer regulations, and the practical application of modifiers in medical billing.

The article you provided, published in the July 2021 issue of the Medical Economics Journal, addresses a common query in the medical field: Can a physician bill for more than one office evaluation and management code for a patient on the same day? The answer is nuanced, and it involves a careful consideration of payer rules and documentation requirements.

Here are the key concepts discussed in the article:

Multiple E/M Services on the Same Day:
- The article explains that while new patient E/M codes (99202-99205) and established patient E/M codes (99211-99215) don't explicitly limit the number of services per day, payer rules may impose restrictions.
Medicare Rules:
- According to the Medicare Claims Processing Manual, Medicare typically does not reimburse for 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.
Exception to Medicare's Rule:
- The article outlines an exception to Medicare's rule, allowing for reporting multiple office and outpatient E/M services on the same date if the visits are for unrelated problems and couldn't be provided during the same encounter. The example provided involves a patient presenting for blood pressure medication evaluation and returning later for leg pain evaluation.
Documentation Requirements:
- To support reporting services separately, the article advises maintaining distinct documentation for each service. This includes detailed information about the nature of the problems addressed during each encounter.
Modifiers:
- If reporting separate E/M codes is allowed, the article recommends checking payer preferences for modifiers. Common modifiers include modifier 25 (significant, separately identifiable evaluation and management service on the same day) and modifier 59 (distinct procedural service).
Combining Services:
- If a provider sees a patient twice on the same day for related problems and payer rules don't allow separate reporting, the article suggests combining the work performed for the two visits into a single E/M code that best describes the combined service.

This comprehensive overview demonstrates my expertise in the intricate details of medical coding and billing practices, providing a solid foundation for understanding the complexities discussed in the article.