2 Visits, 2 different Providers

Valerie813

Networker
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75
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Chicopee, Mass
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I have this scenario: A patient comes in for an E&M visit with a doctor for one problem, and later in the day comes in to see one of our PA's for a scheduled injection for a separate problem. How can I bill this out (he has Medicare)? The 25 modifier does not fit for this situation, but the claims will reject. Any one have some info to help me???

THANK YOU!!!
Valerie
 

btadlock1

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Lubbock, TX
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I have this scenario: A patient comes in for an E&M visit with a doctor for one problem, and later in the day comes in to see one of our PA's for a scheduled injection for a separate problem. How can I bill this out (he has Medicare)? The 25 modifier does not fit for this situation, but the claims will reject. Any one have some info to help me???

THANK YOU!!!
Valerie
Easy - you don't bill an E/M for the PA. It was a previously scheduled injection; therefore, it doesn't warrant an E/M. As long as your rendering NPI's are different, you shouldn't need a modifier. Your doctor's OV claim may deny as incidental to the PA's service, though, so I'd send the claim by paper with records, if that's possible. If not, just make a note on the account to send it for reconsideration if it denies, that way you won't be backtracking to see what the problem was in 30 - 45 days. Hope that helps! ;)
 

MnTwins29

True Blue
Local Chapter Officer
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East Greenbush, NY
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Be sure your MAC accepts paper claims....

if you are going to send records with the initial claim. I used to code for surgeons who used the -22 modifier on occasion and I would need to submit the documentation for support. When I tried to drop the first claim on paper and send the record with the claim, our MAC (NGS) would deny, saying they would only accept electronic claims. When I explained that I knew I would need to send documentation, I was told to first submit electronically, wait for the request or denial, and then send the docs. That was frustrating - only delays payment when I could save a step.
 

Valerie813

Networker
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Chicopee, Mass
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I am sending out both claims- they will be under two different provider numbers. We are going to track it, and if it denies we are going to appeal them with notes. They do accept paper claims. Thanks everyone for all your input!:D
 
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