Wiki 2 Office Consults in Same day

coop22

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We have an established patient that came into the office to see our physician for his follow up on a condition. But suggested that another physician in our practice take a look at it because he specialized in it. They are both in the same group both happend on the same day. One would qualify as 99212 and the other physician did his consult as a new pt 99215 do I use modifier 25? Or bill one?
 
If they are the same specialty then you would combine the documentation and just bill one visit.

If they are different (recognized) specialties you can bill both visits but the new patient would actually go as a new (if they qualify).

Laura, CPC, CPMA, CEMC
 
We have an established patient that came into the office to see our physician for his follow up on a condition. But suggested that another physician in our practice take a look at it because he specialized in it. They are both in the same group both happend on the same day. One would qualify as 99212 and the other physician did his consult as a new pt 99215 do I use modifier 25? Or bill one?

I do not feel mod 25 would be apropriate here. Nothing significant or seperate was performed. This would also not be a new patient. I would combine and bill one code. If the first physicain could not help or access the patient how are you getting a 99212? DId they both evaluate the same sytems?
 
This patient is already established. (Coming in for a routine review) 99212 Our one physician has been following him for his condition. And now he feels that another physician in the same practice may be a better fit because his condition has now worsened. And so now on the same day he did a full consult because this may be a new patient to him but has been in our practice for a couple of years. 99215?
 
I would charge one visit, whether or not that's a 99215, I don't know. Without reviewing the documentation and the medical necessity you can't just say "yes" 99215
 
Well my issue was the first documented a lower visit. Then the second documented a higher and the pt is very high risk. If I were to combine them both yes i would have to go over again but most likely it will be level five for this patient is already established. This is very helpful.
Thank you
 
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