Wiki billing two separate providers under the same TIN and GNPI

[katteev]

Hello,

I have read so much about this, but can't seem to get my claims paid. I bill a NP for 90792 or 99214 and a LMSW for 90832, 90834. In box 31 it has their own name and box 24J has their own NPI. Box 33 has the GNPI and box 25 has the group's TIN. Would the GNPI and TIN be an issue?? I have read they are allow to see patients on the same day and that it's ok they are at the same practice. I have even tried adding their modifiers as well. such as AJ, TD.

Can anyone help me as this? I would really appreciate it!

Thanks

 

[wolbrum]

Hi,
I was wondering if you got any resolution with this? I am also having the same issue. My client does medication management, so one doctor bills the office visit and the therapist bills the 90832-90837, and one is always denied.
Thanks so much

 

[TThivierge]

Hi There, Katteev and Wolbrum,
You can use modifier FS for split shared services used in hospital or clinics or SNF or with Eval Mgt codes. Supposedly the provider who has the longest time treating the patient will be paid. However if pt. seen for differ problems or medical specialties may pay each. Check out modifier 27 it is for differ clinic or outpt. on same date by 2 different providers. This is in effect Jan 2022 for the modifier FS
I hope I helped you
Lady T

 

[DianaICT]

It is because the electronic claims are bundled at the clearinghouse level. Two separate claims must be submitted. I've had this issue before. Both claims for the same date of service and different provider were paid when a paper claim was submitted for one and electronic claim for the other. Each claim was submitted individually and both providers were paid for their services.