When two specialists from the same group bill a hospital E&M visit on the same day we are experiencing denials. Why are our claims being denied?
A. The Centers for Medicare & Medicaid Services (CMS) published evaluation and management guidelines in Chapter 12 of the Medicare Claims Processing Manual. The information below addresses hospital visits on the same day. The following excerpts are taken from Section 30.6.9 (http://www.cms.hhs.gov/Manuals/IOM/list.asp): Two Hospital Visits Same Day Carriers pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not. The inpatient hospital visit descriptors contain the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician should select a code that reflects all services provided during the date of the service. Hospital Visits Same Day But by Different Physicians In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering
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