Billing for two providers of different specialties on the same date of service

tatumroe

Contributor
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I work for a multi-specialty clinic. Often times our patients will see more than one provider on the same date, but of different specialties (i.e. PCP and cardiologist). We are having issues with some of the commercial or MA plans denying the second provider's claim against the first provider claim stating duplicate or previously processed. We do bill as a group under the same tax ID. Does anyone have any insight on how to submit these claims so the insurance will see that the providers are of different specialties and process and pay both claims without having to appeal each denial?
 

TThivierge

Guru
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Lithonia, GA
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Try using modifier 27 - means 2 providers same date different medicine OP services . Or if inpatient stays use modifier 25
Hope this helps
Lady T
 

mitchellde

True Blue
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Columbia, MO
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modifier 27 is for facility use only and is invalid for physician use in any setting. I am not sure modifier 25 is the best friend in this scenario, but it may work. make certain you are not duplicating the diagnosis codes in this situation, each specialist should have only the diagnosis codes they are responsible for on their claim. if a modifier is absolutely necessary then my best suggestion would be XE for different providers on the same day, although I am not certain this modifier is allowed for E&M codes.
 
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You have to contact the payer and notify them that they are indeed two separate specialties. A lot of times its a little fight but once the rep does the research they will send the claim back for reprocessing. There should be no modifier needed if they are registered as a different specialty.
 
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