2 E & M's / seperate carrier

VRcoder29

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I have a NEW patient who came in for an office visit. This office visit is to be billed under a Third party insurance.

While the patient was here for that visit, she had another problem UNRELATED to the first issue. Therefor, the 2nd complaint needed to be billed to her private health insurance.

Is the provider allowed to bill 2 seperate E&M visits on the same day for the same patient.
 

VRcoder29

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The provider documented 2 complete seperate notes for the seperate issues addressed.

These were completely UN RELATED complaints.

1) The COMPANY requested the patient have a hearing eval/exam

then the patient brought up a completely unrelated incident, which could not be billed to the third party carrier because it was unrelated to her hearing problem.

HOWEVER it is something that could be billed to her PRIVATE HEALTH INSURANCE.

Any suggestions
 

rthames052006

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Yes you can bill both visits, this happens quite often where I work, just make sure and I believe you did state this in your follow-up message that there are two notes by the physician.

Two separate complaints and two notes, as long as his notes can stand alone and have all the elements for the level of visits he/she is billing you'll be fine.

It's not double dipping if there are separate complaints and separate work-ups involved.

Roxanne Thames,CPC


I have a NEW patient who came in for an office visit. This office visit is to be billed under a Third party insurance.

While the patient was here for that visit, she had another problem UNRELATED to the first issue. Therefor, the 2nd complaint needed to be billed to her private health insurance.

Is the provider allowed to bill 2 seperate E&M visits on the same day for the same patient.
 

VRcoder29

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Ok great, now would there be any modifiers involved? Would you code the New patient E/M both times?
 

rthames052006

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Ok great, now would there be any modifiers involved? Would you code the New patient E/M both times?
Yes, you would use the np e/m codes both times, not really sure if you need a modifier since they are going out to 2 diff insurance carriers.

Roxanne Thames, CPC
 
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No modifier necessary since it is 2 seperate insurances. But definately be sure the physician dictates 2 seperate records for this date. Have a great weekend everyone!
 

Jackie Stack

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If you are going to bill the seperate insurance companies and have two seperate notes that is ok. We typically don't like to do this. One reason is if the first is say Worker's Compensation and the other is billed to health insurance and the worker's comp company determines that the injury or illness is not work related and they deny the claim (we have work comp claims denied often) then you cannot bill their health ins for this visit because you have already billed for a visit on that day of service. You could be losing reimbursement especially if the comp was billed a higher level of service. We typically see them for comp one day and the other issue at a later date.
 

rthames052006

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You make a great point Jacqueline... I guess there are always going to be "gray" areas in our line of work...

Thanks,

Roxanne Thames, CPC


If you are going to bill the seperate insurance companies and have two seperate notes that is ok. We typically don't like to do this. One reason is if the first is say Worker's Compensation and the other is billed to health insurance and the worker's comp company determines that the injury or illness is not work related and they deny the claim (we have work comp claims denied often) then you cannot bill their health ins for this visit because you have already billed for a visit on that day of service. You could be losing reimbursement especially if the comp was billed a higher level of service. We typically see them for comp one day and the other issue at a later date.
 
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