Multiple E&M visits on the same day for the same patient address instances when a physician(s) or other qualified health care professional(s) reports a single code for multiple medical and/or Evaluation and Management (E/M) services for a patient on a single date of service.
General E/M Code Procedure:
Generally, a single E/M code should be used to report all services provided for a patient on each given day. However, 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 reference, we shared ‘The Medicare Claims Processing Manual, chapter 12, section 30.6.7.B, i.e., office/outpatient E/M visits provided on the same day for unrelated problems.
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The para states that as for all other E/M services except where expressly noted, the Medicare Administrative Contractors (MACs) 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, off the campus-outpatient hospital, or on campus-outpatient hospital setting which could not be provided during the same encounter (e.g., an office visit for blood pressure medication evaluation, followed five hours later by a visit in the assessment of leg pain following an accident).
To support reporting the services separately, you must maintain distinct documentation for each service. You must also check payer preference for which modifier to append to the additional E/M code, such as modifier 25 or 59.
If a provider sees the patient twice on the same day for related problems, the payer doesn’t allow you to report those services separately. 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 return 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 trips into a single E/M code.
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Related Terminologies:
- Same group physician and other qualified health care professional: All physicians and other qualified health care professionals of the same group reporting the same Federal Tax Identification number.
- Same specialty physician or other qualified health care professional: Physicians and other qualified health care professionals of the same group and same specialty reporting the same Federal Tax Identification number.
- 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.
- Modifier 59 (Distinct Procedural Service): Under certain circumstances, indicating that a procedure or service was distinct or independent from other non-E/M services performed on the same day may be necessary. Modifier 59 is used to identify procedures/services, other than E/M services, that are not commonly reported together but are appropriate under the circumstances.
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References:
Medicare Claims Processing Manual, chapter 12
Medical Economics March 2021: E/M coding: Can you bill multiple same-day visits?
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FAQs:
1. Can you bill 2 E&M codes on the same day?
Yes, in some cases, you can bill two E&M (Evaluation and Management) codes for the same patient on the same day, but it depends on payer rules and documentation requirements.
2. What is the modifier for two visits on the same day?
The modifier commonly used for reporting two E&M visits on the same day is modifier 25. It signifies a significant, separately identifiable E&M service provided by the same healthcare professional on the same day.
3. Can 2 E&M codes be billed together?
Yes, two E&M codes can be billed together if the services provided meet the necessary criteria for each code and are supported by appropriate documentation.
4. What are the E&M codes for outpatient visits?
E&M codes for outpatient visits include:
- New patient E&M codes: 99202-99205
- Established patient E&M codes: 99211-99215
5. What are E&M guidelines?
E&M guidelines are criteria established by payers and professional organizations to ensure accurate reporting and reimbursement for Evaluation and Management services. These guidelines typically include documentation requirements, coding rules, and criteria for selecting the appropriate E&M code based on the complexity and nature of the patient encounter.
