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PATIENT HAS TWO VISITS IN ONE DAY

Lori Posted Fri 26th of October, 2012 16:50:01 PM

HELLO,

WE WOULD LIKE TO KNOW IF WE COULD HAVE SOME FEEDBACK ON THIS SITUATION. WE HAD A 13-MONTH-OLD PATIENT WHO WAS BROUGHT IN BY MOTHER AT 10:45 AM AND WAS SEEN BY "DOCTOR A". "DOCTOR A" ORDERED A BREATHING TREATMENT AS THE PATIENT WAS WHEEZING. THEN AT 6:00 PM, PATIENT WAS BROUGHT BACK IN BY MOTHER(WALKED IN - DID NOT CALL TO MAKE APPOINTMENT) AND SAW "DOCTOR B". A BREATHING TREATMENT WAS ORDERED BY "DOCTOR B". THE INSURANCE PAID ON THE SECOND VISIT("DOCTOR B") AND DENIED THE FIRST VISIT ("DOCTOR A")AS DUPLICATE CHARGES. WHEN WE SPOKE WITH INSURANCE, THE SAID THEY WOULD RECONSIDER THE CHARGES IF WE INDICATE THE TIME THE PATIENT CAME IN ON THE CLAIM. OF COURSE, CLAIMS DO NOT INDICATE THIS NOR DO THE ENCOUNTERS INDICATE APPOINTMENT TIME (WE HAVE EMR). ANY SUGGESTIONS? WE APPRECIATE IT.

SuperCoder Answered Mon 29th of October, 2012 17:01:53 PM

Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Billing Instructions

Duplicate visits - are additional visits occurring on the same day for the same patient and billed under the same fee code (e.g. 00100)
To bill duplicate visits occurring less than two hours apart:

• Submit a claim for each visit on a separate line
• Use submission code "D" for the second visit
• Indicate the medical reason for the second visit in the note record (e.g. patient condition worsened; seen for new condition).

Note: If a note record is included for the first visit, the note record for the second visit must be different from the first.

To bill duplicate visits occurring more than two hours apart:

• Submit a claim for each visit on a separate line
• Use submission code "D" for the second visit
• Include the time of each visit in the time field in claim submission
Note: Claims will be processed electronically if you include time.
Multiple visits - are visits occurring on the same day for the same patient and billed under different fee codes (e.g. 00100 for first visit and 00112 for second visit)
To bill multiple visits occurring less than two hours apart:

• Submit a claim for each visit on a separate line
• Indicate the medical reason for the second visit in a note record
To bill multiple visits occurring more than two hours apart:

• Submit a claim for each visit on a separate line
• Include the time of each visit in the time field in claim submission
Note: Claims will be processed electronically if you include time.
Tips: We recommend that you include a note record with all duplicate claims.

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