Hospital Visits

We have a new out of school doc that joined us. He went to school in NC and was trained there. He says that offices there can bill for more than 1 E/M code per day. Is that possible? I'm from TN and we cant do that here unless critical care. I've tried with diff dx and using modifiers. Thanks anyone!

E/m

Rule is once a day same diagnosis. If 2 separate E/Ms for 2 distinct and separate diagnosis, it is possible. In the office or other outpatient setting, there is an exception when the visits were for unrelated problems and could not have been provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident). Documentation must support billing both services separately.

In an inpatient setting, Medicare allows only one E/M per day per physician or physicians in the same group with the same specialty, regardless of whether the encounters are related or not. If one physician is covering for another, e.g., Dr. A sees the patient in the morning and Dr. B, covering for Dr. A, sees the patient in the evening, Medicare does not pay for the second visit. The only exception is when the physician provides an inpatient hospital visit and the patient subsequently requires critical care services

(CMS) Internet Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.5 - Physicians in a Group Practice, Section 30.6.7.b - Office/Outpatient E/M Visits Provided on Same Day for Unrelated Problems, Section 30.6.9 - Payment for Inpatient Hospital Visits, and Section 30.6.15.1 - Prolonged Services with Direct Face-to-Face Patient Contact .