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

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.