Coding a new patient’s 2 visits in 1 day

Q One of our doctors saw a new patient in labor and delivery, and then she was seen in our office for a more extensive exam and ultrasound on the same day, but by a different doctor. Normally I would bill both with a -59 modifier (Distinct procedural service) assigned to an evaluation-and-management (E/M) code, but I was recently told that the -59 modifier should not be assigned to an E/M code. How should I bill for these 2 separate encounters?

A You are correct. While the modifier -59 may be assigned when a distinct and separate service was provided on the same date of service, such as when there is a separate patient encounter, the services referred to in the CPT guidelines are medicine and procedural services, not E/M services. An article in the American Medical Association’s CPT Assistant (January 1999) clarified that the modifier -59 may not be appended to E/M services.

If the patient is seen for the same reason and the physicians are considered the same under the payer’s rules, bill only 1 E/M service for that day, but take into account all of the care the patient received during both encounters to select the right E/M service level. The ultrasound, of course, will be billed as well.

If the payer allows more than 1 encounter on the same day, the second encounter in the office must be reported as an established patient service, since a new patient service applies to the first encounter that day.

There are no appropriate modifiers that can be added to the second E/M service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our doctors saw a new patient in labor and delivery, and then she was seen in our office for a more extensive exam and ultrasound on the same day, but by a different doctor. Normally I would bill both with a -59 modifier (Distinct procedural service) assigned to an evaluation-and-management (E/M) code, but I was recently told that the -59 modifier should not be assigned to an E/M code. How should I bill for these 2 separate encounters?

A You are correct. While the modifier -59 may be assigned when a distinct and separate service was provided on the same date of service, such as when there is a separate patient encounter, the services referred to in the CPT guidelines are medicine and procedural services, not E/M services. An article in the American Medical Association’s CPT Assistant (January 1999) clarified that the modifier -59 may not be appended to E/M services.

If the patient is seen for the same reason and the physicians are considered the same under the payer’s rules, bill only 1 E/M service for that day, but take into account all of the care the patient received during both encounters to select the right E/M service level. The ultrasound, of course, will be billed as well.

If the payer allows more than 1 encounter on the same day, the second encounter in the office must be reported as an established patient service, since a new patient service applies to the first encounter that day.

There are no appropriate modifiers that can be added to the second E/M service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our doctors saw a new patient in labor and delivery, and then she was seen in our office for a more extensive exam and ultrasound on the same day, but by a different doctor. Normally I would bill both with a -59 modifier (Distinct procedural service) assigned to an evaluation-and-management (E/M) code, but I was recently told that the -59 modifier should not be assigned to an E/M code. How should I bill for these 2 separate encounters?

A You are correct. While the modifier -59 may be assigned when a distinct and separate service was provided on the same date of service, such as when there is a separate patient encounter, the services referred to in the CPT guidelines are medicine and procedural services, not E/M services. An article in the American Medical Association’s CPT Assistant (January 1999) clarified that the modifier -59 may not be appended to E/M services.

If the patient is seen for the same reason and the physicians are considered the same under the payer’s rules, bill only 1 E/M service for that day, but take into account all of the care the patient received during both encounters to select the right E/M service level. The ultrasound, of course, will be billed as well.

If the payer allows more than 1 encounter on the same day, the second encounter in the office must be reported as an established patient service, since a new patient service applies to the first encounter that day.

There are no appropriate modifiers that can be added to the second E/M service.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.