There's nothing wrong with having both practitioners see the patient on the same day. But since they're both NPPs, you're very likely to have some duplicate denials from payers for this. Right now, Medicare enrollments don't recognize nurse practitioners as having separate specialties, so you may need to appeal with some kind of documentation showing that the two providers are trained in different specialties. I've had some success in doing this by sending copies of the providers' NPI registries along with the appeals for support. Commercial payers also have different ways of recognizing the specialty of a nurse practitioners which may or may result in denials. It can be a headache to get these paid, but if your documentation supports the medical necessity of separate visits for separate problems, you can bill both services.