How to Bill 2 Visits in the Same Day

If a nurse practitioner or physician sees a patient in the a.m. and again in the p.m. for a new or worsened condition, how is the second visit billed?

 

One of the Medicare Administrative Contractors answered this question on the company website, as a Frequently Asked Question (FAQ). The answer: "[We] would not expect to see two evaluation and management (E/M) services reported on the same date on a routine basis. A second E/M service would be billed for rare circumstances only. If a second E/M service is required on the same date of service, the documentation should clearly provide evidence that the second E/M service occurred, the reason for the additional E/M service, and documentation of the medical necessity of the second E/M service. If a second E/M service is reported on the same date, the service could initially be denied. The denial can be appealed using the appeal guidelines."

The Medicare contractor websites are a great source of information on billing and coding. I recommend that nurse practitioners who see patients on Medicare find out who their local contractor is (Noridian? Novitas? WPS?) and peruse the website, looking at the educational offerings and the FAQs. Sign up for e-mail updates.

 

Source: Carolyn Buppert, NP, JD www.buppert.com.