• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki 2 Visits, 2 different Providers

Create Wiki
V

Valerie813

Networker
Messages
75
Location
Chicopee, Mass
Best answers
0
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
 
Valerie813 said:
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
Click to expand...

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! ;)
 
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.
 
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
 
You must log in or register to reply here.
Top