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Thread: modifiers

  1. #1
    Join Date
    Apr 2007

    Default modifiers

    AAPC: Back to School
    I have 6 physicians in my office. One of the Dr's specializes in surgical oncology. He saw a pt in the office and the patient had a hernia. He does not do hernia surgery and asked another Dr that was also in the office that day to see this patient for the hernia. How do I bill for the second Dr's consultation? Is there a modifier that I should use since I will now have 2 charges- one for each of the Dr's on the same day for the same group.

  2. #2


    I wouldn't use a modifier.

    I would drop the claim to paper and send along with the medical records and a letter explaining the different specialties. This way you give them all the info they need to determine payment from the get go. And, if your group is credentialed as a multispecialty group, you shouldn't have any problems getting it paid and shouldn't have to send in the documentation...

    Also- you say "second dr's consultation" I wouldn't consider this a consultation but rather a referral. The first Dr. knew it was a hernia and since he doesn't do surgery, he's passing the patient off to a surgeon that will. It should be coded as an established patient visit 99211-99215.

  3. #3
    Join Date
    Apr 2007
    Duluth, Minnesota


    I agree with ARCPC9491 in that the second visit is more a referral as opposed to a consult. (so I wouldn't code it as a consult)

    you can bill/code each providers services. They both should have documentation supporting their own services. You can code the initial docs Consult or E/M code (whatever it is) AND the second providers E/M code as well. the modifier .25 would be needed on the second office visit.
    Donna, CPC, CPC-H

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