Wiki IUD insert same day as E/M, but different provider.

kmarceau

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Hey Y'all!

Case Example: A patient comes in to the office for a new E/M regarding birth control methods. The initial provider goes over all the available options, but the patient does not make a decision prior to leaving the appointment. Then, on the same day, the patients returns to the clinic to get an IUD placed, but sees a different provider for the procedure as the initial provider was not available.

Should each provider submit their own claim (one for the E/M and one for the IUD insertion)? Should the E/M and IUD insert be billed with modifier 25 under a single provider, as they both work for the same clinic? Which provider should the services be billed under?

Thanks!
-KM
 
Without seeing the medical records, it's not really possible to say what is correct. But generally speaking, two providers of the same specialty in the same practice should be treated as if they were the same provider for coding purposes. An E/M on the same day as the procedure would only be appropriate if the modifier 25 is supported in documentation indicating E/M service above and beyond the usual peri-operative work. If it is supported, then I'd bill the first provider's E/M, with the modifier, and the second provider's claim with the procedure only.
 
Without seeing the medical records, it's not really possible to say what is correct. But generally speaking, two providers of the same specialty in the same practice should be treated as if they were the same provider for coding purposes. An E/M on the same day as the procedure would only be appropriate if the modifier 25 is supported in documentation. Given that the patient was already evaluated for this procedure at a recent encounter, it's unlikely that a new E/M would be supported unless there was some kind of significant change in the patient's condition or new problem that had come up since the previous encounter that made a new evaluation medically necessary.
Thanks Thomas,

Let me clarify: documentation supports the 99203 for the initial visit where all birth control methods (and other things) were discussed with the 1st provider. The 2nd provider only did the IUD insertion (58300 +J7295), not any additional E/M services. If the patient had seen the same provider both times, documentation would support single claim of 99203:25, 58300, J7295. If the patient had come back the next day for the IUD insert, regardless of which provider they saw, I would only bill the 58300+J7295, with no E/M. It's just the physician split on the same day that threw me. They are the same specialty and within the same practice, so would the 99203:25, 58300, J7295 billed under the 1st provider, or the 2nd? Would it matter?

-KM
 
I would give each provider credit for the work performed.
Provider A 99203-25
Provider B 58300, J7295
with the appropriate diagnoses tied to each.
If the providers were different recognized specialties, then no -25 on 99203.
 
Yes, I agree with Christine above. Bill each of the services under the provider who performed them, and the 25 modifier will be required on the E/M if the two providers are of the same speciality since in that case the payer will process and pay the two claims as if they were by the same provider.
 
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