Question 2 visits on one day--what modifiers should be used in physician's office?

[CSFHC]

Patient was seen initially for wound care, we billed a 11042 and 99213.

Patient tripped and fell outside of the office after her visit. She came back in to the office so we could treat her injury she sustained in her fall.

What modifier do I use on the E/M code for the second visit on the same day?

I see modifier 57 can only be used in a hospital. But is there something like this for a physician's office?

 

[JDACPC]

No modifier is appropriate in this situation. You would combine the notes and submit one code for either total MDM or total time. Here are some recent articles with better explanations:

https://healthcare.trainingleader.com/2024/01/two-em-visits-same-day/

https://healthinfoservice.com/blog/e-m-documentation-and-coding-changes-for-2024/#:~:text=The%20E%2FM%20changes%20include,a%20single%20service%20is%20recorded.

 

[daniel]

Modifier 25

Example
992xxx.25
11042

Second visit for fall
992xxx.25

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.

 

[CSFHC]

Thank you everyone!