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You Be the Coder: 2 Physicians, 1 Diagnosis

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: When the primary-care physician (PCP) and infectious disease MD have both coded the same diagnosis, but the insurance company allows only one MD per day, how should we code so we will also get payment?

Nancy Thurston
St. Francis Hospital
Hartford, Conn.

Answer: If you have provided a valid evaluation and management (E/M) service to your patient, then you deserve to be paid for it. If your claim is being denied because another physician is billing for an E/M service using the same diagnosis, ask for an appeal. You will have to submit your daily documentation, so it is important to tell your physicians to create good documentation that includes the diagnosis that they are specifically treating on that day.

- Published on 2000-03-01

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