Reporting Multiple Outpatient Visits that Occur the Same Day


Hospitals, subject to Outpatient Prospective Payment System (OPPS), report condition code G0 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.

Proper Reporting of condition code G0 (Zero)

  • Hospitals should report condition code G0 on FLs 24-30 when multiple medical visits occurred on the same day in the same revenue center but the visits were distinct and constituted independent visits. An example of such a situation would be a patient 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.
  • Claims with condition code G0 should not be automatically rejected as a duplicate claim
  • Proper reporting of condition code G0 allows for proper 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.

Evaluation & Management (E&M)
Revenue Center
Condition Code
OCE Action
2 or more
Two or more E&M codes have the same revenue center
No G0
Assign medical APC to each line item with E/M code and deny all line items with E/M code except line item with highest APC payment
2 or more
Two or more E&M codes have the same revenue center
G0
Assign medical APC to each line item with E/M code

Reference: Medicare Claims Processing Manual (PDF, 1.2 MB), Chapter 4, section 180.4 - Proper Reporting of Condition Code G0 (Zero).





Last Updated: 01/10/2019