Wiki E&M + Vascular ultrasounds

[adankert16@gmail.com]

Hello I have a question,
We do in house vascular ultrasounds along with E&M visit that are on the same day but on different claims. Patients are getting 2 copays one on the office visit and one on the ultrasound ( we are aware some may have a diagnostic copay on top of an OV copay). Can we get a clarification if mending a 25 modifier on the Office visit would the patient only get charge one copay, or should we put them on the same claim. We are being told by some patients that their insurances are charging them the diagnostic copay because it being sent on 2 separate claims. Confused??

Thank you

 

[csperoni]

If a patient has a separate diagnostic copay in addition to an office visit copay, they will owe both regardless of whether it is 1 or 2 claims.
Putting -25 on an E&M service that does not require it should never be done and should not affect patient responsibility if insurance is processing claims correctly. The purpose of -25 is when and E&M is being bundled with an additional service, and you need to indicate to the payor that the E&M was separate and the work of the E&M was not part of the pre & post work of the other service.
I believe your patients telling you this are misinformed. Even if the insurance processed it incorrectly and patient should have owed less, then the insurance should be able to correct the processing.
I personally would suggest billing all charges for the day for the same patient under the same provider on 1 claim when possible from a logistics perspective. You create less work overall for yourself and the carrier by doing so. That would also help mitigate the insurance possibly making a claim processing error.