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SAME DAY VISIT TO DIFFERENT DOCTOR FOR SAME REAON

Daniel y Posted Tue 28th of October, 2014 11:58:20 AM

Can we get pay for office visit when patient already went to other ophthalmologist on same day and was already billed?

SuperCoder Answered Tue 28th of October, 2014 13:55:32 PM

In this scenario, you have two physicians in the same group who are not in separate specialties . Both doctors see the same patient in the office on the same day. You cannot bill two separate codes for the same-patient, same-day services.

Combine the two physicians’ work and submit one E/M code, such as 99215. Combine the E/M components of both visits and bill the higher E/M code. This must be carefully documented, however. “If most of the visit was spent in counseling and/or coordinating care for the patient, it may be better to report the combined time of both services to justify a higher level of service.

According to MLN Matters article MM4032, “Carriers 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 or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of headache following an accident).” You can read this article at www.cms.gov/mlnmattersarticles/downloads/MM4032.pdf.

Hope this helps.

Daniel y Posted Tue 28th of October, 2014 15:57:15 PM

It is two same specialty doctors with two different groups. It is also same code 92014.

SuperCoder Answered Wed 29th of October, 2014 08:13:39 AM

Since you are not in the same physician group you can bill separately however it is possible the insurance may deny based on the same code billed on the same date of service. You may need to send in documentation with the claim for the reasoning of the second physician. If you receive a denial you may have to appeal or change to an E/M code.

Hope this helps.

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