Multiple and Duplicate Visits on the Same Day Take quiz

Occasionally a patient will visit their doctor more than once in the same day. The following information will clarify when it is appropriate to bill more than one visit on the same day for the same patient. For a definition of '"visit" and included services please see Preamble B.4. of the MSC Payment Schedule

More than one visit may be billed for the same patient on the same day when:

The patient is seen for a visit to assess one specific problem, and presents later in the day with a new condition;
The patient is seen for a visit to assess one specific problem, and presents later in the day because the condition has worsened significantly and requires a new assessment.

More than one visit may not be billed for the same patient on the same day when:

The patient returns to the office to receive additional information regarding their condition than could reasonably be expected to have been included in the initial visit. For example if a patient is asked to return for treatment advice and does not require a new assessment, a second visit would not be billed.
The patient is seen for multiple problems during the same visit.

Billing Instructions

Duplicate visits - are additional visits occurring on the same day for the same patient and billed under the same fee code (e.g. 00100)

To bill duplicate visits occurring less than two hours apart:

Submit a claim for each visit on a separate line
Use submission code "D" for the second visit
Indicate the medical reason for the second visit in the note record (e.g. patient condition worsened; seen for new condition).
 

Note: If a note record is included for the first visit, the note record for the second visit must be different from the first.

To bill duplicate visits occurring more than two hours apart:

Submit a claim for each visit on a separate line
Use submission code "D" for the second visit
Include the time of each visit in the time field in claim submission
  Note: Claims will be processed electronically if you include time.
Multiple visits - are visits occurring on the same day for the same patient and billed under different fee codes (e.g. 00100 for first visit and 00112 for second visit)

To bill multiple visits occurring less than two hours apart:

Submit a claim for each visit on a separate line
Indicate the medical reason for the second visit in a note record

To bill multiple visits occurring more than two hours apart:

Submit a claim for each visit on a separate line
Include the time of each visit in the time field in claim submission
  Note: Claims will be processed electronically if you include time.
Tips: We recommend that you include a note record with all duplicate claims.
  You can read more about billing Multiple and Duplicate visits in Section 6.1 of the MSP Resource Manual for Physicians.
  This information does not specifically relate to hospital/institutional visits. An MSP Tutor module is under development for hospital/institutional visits and will be available soon.

 

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