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Wiki E/m by different providers under different specialties

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cldrew

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I am receiving denials from United Healthcare for inpatient subsequent E/M services by two different physicians of two different specialties under our multi-group practice. The insurance is stating I need a modifier. I have never used a modifier on an E/M code and do not feel a 77 modifier is appropriate. Has anyone came across this issue or have any idea what modifier is appropriate. Any help is appreciated
 
When I worked for a multispecialty group I just called the insurance and explained to them that two different specialty's saw the patient and there should be different dx. There is no modifier to use. They should just reprocess the claim.
 
We have this same issue with Humana mostly. I don't recall having an issue with any other insurances in our practices. And they fight with us on adding a 24 modifier when it is after a surgery. It's very frustrating to have to call them on every claim! :)
 
Its as if you were reading my mind... LOL

We have been having the same issue with UHC minus the modifier. Two providers sam e day same specialty that really are not in the same specialty. They keep saying our issue is because several of our subspecialists are also boarded in IM. So we are being denied because our MD's are boarded more than once... LOL!! We can't be the only multispecialty group with this happening. We have their subspecialties first and everything and we have to call on everyone to have them "REPROCESS" the claim. OBSURD!!!

Thank you for allowing me to share/ vent. :)
 
amsmith said:
We have been having the same issue with UHC minus the modifier. Two providers sam e day same specialty that really are not in the same specialty. They keep saying our issue is because several of our subspecialists are also boarded in IM. So we are being denied because our MD's are boarded more than once... LOL!! We can't be the only multispecialty group with this happening. We have their subspecialties first and everything and we have to call on everyone to have them "REPROCESS" the claim. OBSURD!!!

Thank you for allowing me to share/ vent. :)
Click to expand...

I understand! Thanks for letting me vent as well! :)
 
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