Customize Your Solution to Accomplish All Your Compliance & Reimbursement Goals CLICK FOR FREE CONSULTATION

Ask an Expert

Answers to Compliance and Medical Coding Questions.
  1. Chris Posted 4 Year(s) ago

    A patient was seen twice in one day by 2 different physicians. There does not seem to be an appropriate modifier for this scenario. The patient was seen during the day and then returned in the evening, where the physician sent the patient to the er. First visit was coded a 99213 and the second was coded a 99215.

  2. SuperCoder Posted 4 Year(s) ago

    First of all, two visits should not be billed on the same day. As per E/M guideline, you should combine the levels for both the visits and should report the appropriate higher level if both the physicians are in the same specialty. If they are different specialty (not covering for each other) and for different reasons with different dx, then probably you could bill both the services by appending modifier -25 in the second service to indicate that second visit is separate and different from the first visit. You should provide brief explanation of the separateness for both the encounters with clear documentation that should support appropriateness of medical necessity and should warrant for billing both the encounters for the same day.

About this Question

  • Posted by 12414 Chris, 4 Year(s) ago. There are 2 posts. The latest reply is from SuperCoder.