Question Billing for multiple units of 99291 on the same date of service at 2 different servicing locations

CBLENNIE

Networker
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29
Location
Meridian, ID
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0
I have a curious situation where an ER physician billed 99291 twice on the same date of service, but at 2 different servicing facility locations. Both facilities are part of the same major hospital system in our area, the first facility is a small medical center and only has an emergency room, the second claim was submitted for the main hospital which is our area’s trauma center.

I know that 99291 is supposed to be limited to one time per day per physician but the CPT guidelines do not address whether this limit applies if the provider renders these services at 2 different facility locations. Can the physician bill a unit of 99291 for each servicing location where services are provided to the patient?

If anyone has any reference materials to point me towards an answer to this question, I would greatly appreciate the information.
 

SharonCollachi

True Blue
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2,171
Location
Clovis, CA
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3
It really isn't necessary to post the same question in more than one place.

If the same provider, same tax id, renders the same service in one day with the only change being a different pos, then the 2nd will likely get denied as inclusive to the first. You can always appeal.
 

CBLENNIE

Networker
Messages
29
Location
Meridian, ID
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0
I should've explained that I work for the payer and we're trying to figure out how these claims should be handled because we've suddenly started receiving them from one of our contracted ER physician groups. It is not addressed in their contract and they do not work for the facility so it is not covered by the facility's contract either.

We use Encoder Pro - Payer Edition for our coding software and it doesn't provide any direction regarding the service being billed for 2 different servicing locations, so we are struggling to figure what is appropriate.
 
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