Q/A: Reporting multiple outpatient visits that occur the same day
APCs Weekly Monitor, June 17, 2011
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Q: Some of our outpatient claims contain multiple charges reported with revenue code 0761 (treatment room) and multiple facility E/M codes for the same date of service. Is this correct?
A: You may report multiple medical visits and services on the same date of service, but the provider must exhibit due diligence.
Review these charge line-items against the medical record documentation and each department’s E/M mapping criteria to ensure accuracy and reliability e. Then review the Medicare Claims Processing Manual, Chapter 4, §180.4 – Proper Reporting of Condition Code G0 is your next step.
Hospitals subject to Outpatient Prospective Payment System (OPPS) report Condition Code G0 on FLs 24-30 (or the corresponding electronic location) when multiple medical visits occurred on the same day in the same revenue center (0450, 0761, 0510) but the visits were distinct and constituted independent visits. An example of such a situation would be a beneficiary going to the emergency room twice on the same day, in the morning for a broken arm and later for chest pain.
Multiple medical visits on the same day in the same revenue center may be submitted on separate claims. Hospitals should report condition code G0 on the second claim. Appropriate reporting of Condition Code G0 allows for accurate payment under OPPS in this situation. The OCE contains an edit that will reject multiple medical visits on the same day with the same revenue code without the presence of Condition Code G0.
Editor’s note: Denise Williams, RN, CPC-H, director of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.
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