OBGYN Coding Guidelines: Billing for 3 Visits in 3 Days

Sometimes, a provider may choose to evaluate a new patient over multiple days rather than in a single visit. While clinically reasonable in some cases, billing for services provided across separate dates requires careful consideration and attention to detail. The example below outlines how such a scenario should be handled under current coding guidelines.

Scenario OBGYN Coding And Billing for 3 Visits in 3 Days

A provider plans to see a new patient over three separate days, with each visit focused on a different component of the evaluation:

• Day 1: Video Visit
• The provider meets with the patient by video and obtains the patient's history.
• Day 2: In-Person Visit
• A physical examination is performed in the office.
• Day 3: Video Visit
• The provider discusses the assessment and plan with the patient.

Can You Submit Charges for All Three Days in OBGYN Coding?

Technically, since each visit occurs on a separate day, however, there are limitations based on billing and documentation requirements that affect the amount you can bill and whether each visit qualifies as a separate Evaluation and Management (E/M) service.

Visit-by-Visit Billing Review

• Day 1: History Gathering (Video Visit)
• This visit may be billed, but it must be reported using time-based coding only. Since the assessment and plan are deferred to a later visit, medical decision-making (MDM) does not apply for this date.
• Day 2: Physical Exam Only (In-Person Visit)
• This visit generally does not meet the requirements of a billable E/M service. Performing only an exam without additional history or medical decision-making (MDM) is insufficient. Repeating what was already done on Day 1 may not be considered medically necessary.
• Day 3: Assessment and Plan (Video Visit)
• This visit can be billed using either time or MDM, as it includes the clinical decision-making portion of the evaluation.

Key Points to Keep in Mind

• Only work performed on a single date of service can be billed. You may not combine documentation from multiple days to justify a single Evaluation and Management (E/M) code.
• Billing for three consecutive days for the same patient may prompt payer review, primarily if documentation does not support medical necessity and compliance.
• The Day 2 visit is unlikely to be reimbursable unless all required E/M elements are clearly documented and medically necessary.

Conclusion

When splitting a new patient evaluation across multiple dates, be sure each visit stands alone in terms of coding criteria. In this scenario, billing for Day 1 and Day 3 is appropriate, while Day 2 may need to be written off unless further documentation supports it as a complete and medically necessary service.

Simplify Multi-Day Patient Encounter Billing with BillingFreedom

Handling billing for patient care spread across three separate dates can be challenging. When care includes a remote session for history, an in-person session for the exam, and a final remote session for planning, each date must meet individual billing standards. The middle session, which is often limited to an exam, frequently falls short of billing requirements, potentially leading to payment issues or denied claims.

BillingFreedom Ensures Clean, Compliant Claims

BillingFreedom’s expert team helps practices manage such cases with precision in OBGYN medical billing and coding. Each session is assessed independently for proper coding, whether by time or decision-making criteria. This approach ensures accurate billing while keeping your practice in line with payer rules. 

Trust BillingFreedom to handle complex schedules and protect your bottom line with efficient, compliant claim submission.

For more details about our exceptional OB/GYN medical billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472. 

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