Wiki Multiple Claims for Same DOS

[Tracey Thompson]

I have several instances in physical therapy that providers are using an EMR software which differentiates between each treatment cycle for a patient. When this happens, I am receiving two claims for the same patient, same provider, same CPT codes, but different diagnosis codes. Is this compliant?

My thoughts are that CPT codes such as 97110 are to be billed in multiple units according to the time spent on one claim with each diagnosis code also listed.

The provider's argument is that the patient is being seen for two separate injuries and is receiving two separate treatments.

Can anyone give me some enlightenment????

Thanks!

 

[AKSpectrum]

You can use a modifier - 59 on the second set of 97110 and point to the the different diagnoses.