Wiki Exact duplicate claim/service

[MandyMW1]

We have a patient that was sent back to us with a new diagnosis for evaluation for PT. This was <12 months after the first eval was billed, but does have the exact same line items as the first evaluation.

When a patient is referred for a new evaluation for a seperate diagnosis, is there a modifier to include on the eval code or should it have been considered a re-evaluation.

Lastly, is there any way to save this claim?

ETA: upon further digging, this person was direct access for the initial eval, arrived in 2021 with a referral.

 

[trarut]

The fact that it's clearly a different date of service and different diagnosis should be enough. If the payer is denying, you will need to appeal with an explanation and records showing this was a new referral for a new issue.