Can one visit be billed to two insurance companies?

yms

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The doctor saw a patient for two different reasons (condition related to workers comp and other general health condition) on the same day (same visit) hence he raised two different documentation and billed one to workers comp and other to health insurance. But the TOS is same or jus 2-3 mins difference. Can this be done?
 

trixiebh

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Yes. The Worker's Comp visit would be posted to the Comp carrier. Dictation for that visit must only include information pertaining to the WC visit. The regular office visit would be billed to the patient's insurance carrier. The dictation for this visit must only include information pertaining to the office visit and no information about the WC visit. There should also be two billing sheets. One for the WC visit and one for the regular office visit.

Hope this helps.
 

shruthi

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I have similar question related to this.
I have come across a scenario where doctor has billed 2 E&M codes on same day for 2 different ins (MVA and HI) with 2 separate office visit reports (timings different)
Can this be done?
 

ashlee59

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No, there is no reason to file to 2 different insurances. If the patient had an accident, it should be files to his auto insurance or the other person's auto insurance first. If that insurance doesn't pay because there is no coverage or the coverage is exhausted, then the claim can be billed with the EOB from the auto insurance to the patient's healthcare insurance. The Dx should be what the injury is and the use of an E code to show where it happened, etc.
 

dclark7

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I would have to differ with ashlee59. It depends on the scenario. I've seen patients come into the office for a visit in the morning and then have something happen (MVA, slip and fall, etc) and come back to be seen at a different time the same day for an entirely different problem. In the case that shruthi is asking about it could be possible that this is valid. Based on the limited information that she gave and without reviewing the office notes it is impossible to make that determination.
 

shruthi

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Thanks Doreen.

I will explain the above scenario with example that i have come across.

First office visit was billed with 99213 and submitted to MVA ins with the Dx related to injury (ankle). Documentation in HPI and assessement also supports its an MVA case.
Second office visit was also billed with 99213 and submitted to HI with sick visit Dx (back pain). Document also suggests that patient has come for back pain.
First visit and second visit has taken place on same day and with the time gap of 15 min.

Kindly review and suggest your points.
 

ewinnacott

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I would probably put a modifier -25 on the 2nd office visit. We have instances where our spine doctor and our pain management doctor have seen the same patient on the same day for different reasons within a half hour of each other and we use the modifier -25 on the 2nd office visit. Hope this helps
 

yms

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In ewinnacott scenario, the doctors differ but the insurance is same, but here the scenario is same doctor, two service but two different insurance, if we assign modifier 25, the claim which has modifier 25 is going to get denied by the insurance as invalid modifier as there are no other CPT billed along with 99213.
 
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