Double OV Codes May Land You in a Tightspot

Double OV Codes May Land You in a Tightspot

Scenario: In the morning, one of our ophthalmologists treated a patient for a LASIK evaluation. That afternoon the patient returned to see a different doctor, within a practice of many doctors for a diabetes check that was not related to the first visit. Here can we report both established patient visits?

Well, this is always a sticky wicket for coders. Normally, most carriers will not reimburse for two office visits on the same day particularly if they're for the same condition or problem and the patient is treating two physicians with the same specialty designation from the same practice. However, in your case there are different diagnoses.

Carriers will most probably ask why the physicians could not see the patient for both LASIK evaluation and the problem visit during the same office encounter. If the group of physicians is under one tax identification number, you'll not be able to submit both Evaluation & Management services provided on the same day.

Ask yourself: Was the LASIK consultation considered medically necessary, and as such, it's a reportable service? If not, does the patient have insurance coverage for a LASIK evaluation? Many payers don't pay separately for this service. The cause for the visit (LASIK evaluation) is not the same type of evaluation as for glasses and contacts, even though the ophthalmologist may carry out much of the same workup. Other payers take the LASIK consultation part of the pre-operative component of the LASIK procedure and not payable separately.

The cause of the visit is to assess whether the patient's a candidate for LASIK surgery with a discussion of the procedure, cost and the like. Many practices offering LASIK surgery cover the evaluation as part of the procedure's cost or no cost.

What you should do? If your payer considers the LASIK evaluation part of the procedure and as such not billable, you should be able to report the second ophthalmologist's service for the diabetes checkup. Or else, you'd need to combine the work of both physicians and report one evaluation/management service under whichever physician you choose. But then you can't combine work for non-covered service under whichever physician you choose. But again you cannot combine work for non-covered services. As such, if the LASIK evaluation is thought of as non-covered, don't determine the level of E/M codes assignment using the work carried out during the LASIK consultation combined with the diabetes check.

Best option: Ask the individual carriers how they want you to report multiple same-day office E/M visits, keeping in mind the reason for each visit (LASIK evaluation and problem visit by different providers). Your ophthalmologists' documentation must support medical necessity for both services with the corresponding diagnosis.

Tip to remember: Always report two hospital visits on the same day with one CPT code. Combine the work at both visits to settle on the service level to code. You may keep this same coding principle in mind and follow it when you're also reporting two office visits on the same day.

While dealing with more than one diagnosis in the office setting, many a time the increased medical decision making for the two different diagnoses may lead to the documentation of a higher level of care for the combined visits. However, remember that medical decision making alone is not the only criterion you need to meet for the level of service.

For more on this, sign up for a medical coding guide like Supercoder.

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