Wiki Help!! 2 Doctors, Registered as 2 different specialists/ same office

[repmed01]

2 Doctors / Registered as 2 different specialists (2 different taxonomy) / same office/ same tax id and NPI. Claims being denied as inclusive or a duplicate. How can I get these paid. Dr 1 is pain management, Dr 2 is Neurology. Will a 25 modifier work?

 

[catherinetinkey@entmedicalservices.org]

There are many offices/health systems that have multiple specialties under one tax ID. Are they new or return patients? Are the both billing the same CPT codes? Diagnosis codes should be different. You can only use modifier 25 if the same physician is performing another service on the same day. There taxonomy and different ICD-10s should be enough.

diagnosis codes, diagnosis coding

 

[repmed01]

Yes both billing an office visit. They are billing both new and established.

diagnosis codes, diagnosis coding

 

[trarut]

I'm going to disagree with this. I used to work at a practice with oncology, gyn oncology, radiation oncology and palliative medicine. We successfully used 25 modifer on EMs when patients were seen by multiple specialties on the same day. The documentation just needs to be very clear about the reason for each visit to justify the 25 modifier. (It's been a few years and payer rules are changing with regards to 25 modifier so take that into account.) I do suggest looking at some payer policy documents for use of 25 modifier as that will help you understand what the payers do and don't accept.

diagnosis codes, diagnosis coding

 

[kdlberg]

I would make sure the payer has the correct taxonomy codes for both providers. That's a place where I've seen mistakes.

diagnosis codes, diagnosis coding