Wiki 2 providers 1 patient same day DIFF.SPECIALTIES

[NICHOLSKALA]

What modifier can I use for denied claims when 2 providers see the same patient on the same day? Long term care setting. A NP sees pt then the physiatry doctor sees the patient. Same practice but one provider is a specialist and the other is a physicians assistant or NP... we get denials but I know there has to be a modifier to get the claims paid?? HELP PLEASE. THANKS IN ADVANCE

 

[thomas7331]

You can try the XP modifier but in this situation you will probably need to appeal with documentation that the mid-level providers are trained in different specialties. I've found that a lot of payer systems are not set up to accurately handle specialties for NP or PA providers.

 

[CodingKing]

Also remember just because they are an NP doesn't automatically mean they are a different specialty. An MD, NP & PA can still be considered the same specialty

You can try the XP modifier but in this situation you will probably need to appeal with documentation that the mid-level providers are trained in different specialties. I've found that a lot of payer systems are not set up to accurately handle specialties for NP or PA providers.

Coming from the insurance company its hard to keep track as some of them switch specialties often. Also the NPI database they just list as NP or PA. Usually we just go with their supervising physicians specialty but that doesn't help on states where NP PA don't need a supervisor. Plus many offices are slow to notify of changes.

 

[NICHOLSKALA]

1 provider is a physiatry doctor the other is a family practice NP

Thanks for your help on provider is a physiatry doctor the other is a family practice NP and t g e denials are increasing! We try to tell them just see pts on opposite days but that's not working. I will give the XP modifier a try.