With every near year comes new coding guidelines, and CPT definitely delivered a lot of E/M changes over the past few years. Most recently, the AMA provided new clarifications on how to report two E/M visits on the same date of service.
If you see a patient twice in the same day — whether it’s for one problem or separate issues — check out the following three tips to discover how you’ll claim reimbursement for two E/M visits on the same day.
1. Aggregate MDM or Time When Both E/Ms Are in Same Setting
If the same provider (or different providers of the same specialty and subspecialty belonging to the same practice) see a patient more than once on the same date of service in the same setting, CPT has clarified that you’ll submit just one E/M code, using the following criteria:
- When using medical decision-making (MDM) to select the code, you’ll aggregate all MDM from that date of service together and use that to level your service.
- When using total time to select the code, you’ll add the times of the two visits together to find the most accurate E/M level.
For example: Dr. Smith sees an established patient in the office in the morning for a sinus infection and spends 15 minutes with the patient. That afternoon, the patient returns fearing an anaphylactic reaction to some shellfish. The doctor examines him, spending 15 minutes total, and determines that the patient is just experiencing symptoms of a virus. To code these two visits, you’ll add the times together to get to 30 minutes and report 99214, which is the time-based code that correlates to 30 minutes of total time.
2. Separate Settings? Don’t Count Time Twice
If you see a patient in separate settings on the same date of service, you should not add the time together, even if you were accustomed to billing that way for years. Instead, you can report two separate E/M codes with modifier 25 appended.
For instance: Suppose your cardiologist sees an established patient in your office in the morning for a routine medication check-in. The physician spends 20 minutes with the patient and she leaves the practice. Later that afternoon, the patient presents to the hospital with a heart attack and your physician admits her there, spending 75 minutes on her care. In this situation, you will report 99223 for the initial inpatient care and 99213-25 for the morning E/M service at the doctor’s office.
3. Check Special Rules for Hospital Discharges
When it comes to patients who are discharged from the hospital and then admitted again on the same date of service, the rules vary depending on where the readmission occurred.
- Discharge services and services in the same facility: If the patient is discharged and readmitted to the same facility on the same date of service, report a subsequent care service instead of a discharge or initial service — this would be considered a single stay.
- Discharge services and services in a different facility: If the patient is admitted to another facility, it’s considered a different stay — discharge and initial services may be reported as long as time spent on the discharge service is not counted toward the total time of the subsequent service reported when leveling the code based on time.
Therefore, scrutinize the records in this situation to confirm whether the patient was readmitted to the same hospital or a different one, since the coding is very different in these situations.
Stay on top of the 2024 E/M coding changes with key tips from expert Dreama Sloan-Kelly, MD, CCS, CPC. During her online training, G2211: Collect $16 More Per E/M Visit in 2024 With Key Tips, she’ll provide you with actionable tips that can help you code and bill properly to collect maximum income this year. Register today!
Check out our Coding and Billing Playlist on YouTube for the latest expert advice, and subscribe to our YouTube channel for step-by-step guidance!
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