Wiki Concurrent care or combined E/M?

[jek521]

I code for an oncology group practice where there are physicians of different sub-specialties: medical oncology, hematology/oncology, neuro-oncology.

When two physicians of different sub-specialties each manage an aspect of a patient's care and see the patient on the same day, should the two visits combine for a single E/M? I read an old article (from when the concurrent care modifier was discontinued) that suggested billing separately for each sub-specialist. Not many insurances agree & deny the claims.

Oftentimes, the visits meet the criteria for high level E/M codes but not the time requirements for prolonged services.

Thanks for any help & suggestions!!
Jen

 

[melheffley]

I understand completely where you are coming from. I don't have an answer for you, but have a similar situation.

I have pondered this very question for quite awhile with no answer. I bill for a cardiologist, as well as an electrophysiology sub specialist. We are not only getting denials from insurance for the subspecialties, but against visits by other physicians (internal med or even a different specialty) of our practice on the same day. There is one insurance in particular that still says there is a concurrent care modifier that needs to be put on these claims, but will not tell us what one they want.

For example: Patient is admitted to inpatient for chest pain and abnormal EKG. The day after admission, the patient is seen for a subsequent hosp visit by our cardiologist (dx 786.50) and our nephrologist (dx 276.8). The visit for the cardiologist was denied as bundled. Even after submitting an appeal with the notes from both physicians showing the necessity, they continue to uphold their denial, stating we need to append the concurrent care modifier. In one letter, they even go on to say that "this situation may be reported by adding modifier 77 to the repeated procedure/service". By all documentation that we find, a 77 cannot be put on an e/m service.

Is this type of situation something that would justify a 25 modifier? We have always thought of the 25 to be a separate procedure by the same physician.

If anyone else has ran into this and found a solution, or a reference to check out, your help would be greatly appreciated.