Mutiple Visits - same Tax ID

LeaHarris

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Does anyone have any experience or knowledge regarding billing multiple visits on the same date of service under the same tax ID number? I code for a rural family practice clinic and they are wanting patient's to be able to schedule multiple appointments in one day (if needed), like a "one-stop shop" but I am concerned about getting paid for multiple visits on the same DOS. We are looking at potentially billing a PCP visit, acupuncture visit, dental visit and behavioral health visit on the same DOS (not that all of these visits would happen in one day but two at a time). The problem is, all these providers work under the same tax ID number, so how do I get insurance to pay for these claims? Even if the diagnosis are not the same, what are my chances of getting paid? Someone mentioned modifier 25 on the highest E/M but then only that E/M would be reimbursed? I also heard mention of a G0 modifier. Is this even possible?

I appreciate any suggestions anyone may have!
 

mhstrauss

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Does anyone have any experience or knowledge regarding billing multiple visits on the same date of service under the same tax ID number? I code for a rural family practice clinic and they are wanting patient's to be able to schedule multiple appointments in one day (if needed), like a "one-stop shop" but I am concerned about getting paid for multiple visits on the same DOS. We are looking at potentially billing a PCP visit, acupuncture visit, dental visit and behavioral health visit on the same DOS (not that all of these visits would happen in one day but two at a time). The problem is, all these providers work under the same tax ID number, so how do I get insurance to pay for these claims? Even if the diagnosis are not the same, what are my chances of getting paid? Someone mentioned modifier 25 on the highest E/M but then only that E/M would be reimbursed? I also heard mention of a G0 modifier. Is this even possible?

I appreciate any suggestions anyone may have!

In general, having the same tax ID shouldn't be a problem. Medicare, and any other payers that follow Medicare guidelines, process services by the provider's NPI, which is registered under a specific specialty. You should be able to bill, and be paid for, 1 visit for each specialty type per DOS with no problems, as long as each visit is billed out under that specific provider's own NPI.

I'm not certain about dental or acupuncture services, I don't have any experience with these. Do they have NPI numbers? Are dental services billed out with E/M codes?
 

erjones147

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To piggyback on this...

I work at a tribal clinic, and we have no problem getting multiple visits paid. The only exception is we can't bill for 2 E/M codes on the same date, so we are screwed if the patient sees the doctor and the psychiatrist on the same day. We've had one patient get paid for medical, dental, chiro, optometry, and psychologist on the same DOS with 5 separate claims - very busy day for that patient ;)

Everything else gets paid - dental codes bill out using ADA codes from the CDT, so you're good there, as well
 
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