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Modifier for two visits on same day

  1. #21
    Location
    North Carolina
    Posts
    3,126
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    Exam Training Packages
    But again...for the purpose of Medicare, you need to combine the services...."Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level"....

    For other carriers, that don't follow CMS guidelines, it's possible to bill for both. It will depend on that's carriers guidelines. Like most, once Medicare sets a "standard", others follow suit.

  2. #22
    Location
    Seattle First Hill
    Posts
    126
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    I agree Rebecca, our clinic combines the visits and codes appropriately. And we're finding that more and more carriers are following Medicare guidelines.

  3. #23
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    Quote Originally Posted by mitchellde View Post
    First, the 27 modifier is for facility billing only.
    Second, if your NPs are in the same specialty, then you will not be successful with trying to bill 2 visits on the same day. If you provide more information I might be able to give more help. Such as are both NOPs in same tax ID, and what was the dx for each encounter, and the need for 2 encounters on the same day.
    Thanks for you Kind reply...

    Two NP's are belong to same group & having Same Tax ID. Herewith i have given some patient visits... Please help me by checking these examples

    Patient 1:
    1st visit - 707.03 & CPT 99255
    2nd visit - 682.6,465.9 & CPT 99309

    Patient 2:
    1st visit - 707.03 & CPT 99308
    2nd visit - 783.21,454.0,285.9 & CPT 99310

    Patient 3:
    1st visit - 892.0 & CPT 99307
    2nd visit - 482.9,428.0,288.50 & CPT 99316

    In all above said visits, I billed it with 27 & got denied from Medicare. Now what i have to do to bill this visit, if there is no other modifier means can i move second visit to patient directly from MCR.

    Once again Thanks for your Kind timely help

    Thanks,
    Soundar

  4. #24
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    Quote Originally Posted by rebeccawoodward View Post
    I'm with Debra on this....

    Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    30.6.5
    Hi Rebecca,

    Thanks for this wonderful link..

    I have sent the examples in previous thread, please check with that also & help me

    Thanks,
    Soundar

  5. #25
    Location
    Columbia, MO
    Posts
    12,570
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    Quote Originally Posted by SoundarR View Post
    Thanks for you Kind reply...

    Two NP's are belong to same group & having Same Tax ID. Herewith i have given some patient visits... Please help me by checking these examples

    Patient 1:
    1st visit - 707.03 & CPT 99255
    2nd visit - 682.6,465.9 & CPT 99309

    Patient 2:
    1st visit - 707.03 & CPT 99308
    2nd visit - 783.21,454.0,285.9 & CPT 99310

    Patient 3:
    1st visit - 892.0 & CPT 99307
    2nd visit - 482.9,428.0,288.50 & CPT 99316

    In all above said visits, I billed it with 27 & got denied from Medicare. Now what i have to do to bill this visit, if there is no other modifier means can i move second visit to patient directly from MCR.

    Once again Thanks for your Kind timely help

    Thanks,
    Soundar
    It is not making sense to me why there is a need for these as two separate encounters on the same day by NPs in the same practice and same specialty. In example 1 why a consult and a nursing home visit on the same day, when one of the providers could have assessed all three problems. And the same wth each of the other scenarios. Is there anything in the documentation that supports why it was necessary to be examined on two different visits on the same day?
    As previously stated you cannot use a 27 modifier for physician billing. And as Rebecca pointed out you should combine the visits for one E&M code.
    Also on the last visit why one visit and then a discharge on the same day. I am sorry that I am not being more helpful but this just does not make sense to me. Any thing else you can give me?

    Debra A. Mitchell, MSPH, CPC-H

  6. #26
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    Quote Originally Posted by mitchellde View Post
    It is not making sense to me why there is a need for these as two separate encounters on the same day by NPs in the same practice and same specialty. In example 1 why a consult and a nursing home visit on the same day, when one of the providers could have assessed all three problems. And the same wth each of the other scenarios. Is there anything in the documentation that supports why it was necessary to be examined on two different visits on the same day?
    As previously stated you cannot use a 27 modifier for physician billing. And as Rebecca pointed out you should combine the visits for one E&M code.
    Also on the last visit why one visit and then a discharge on the same day. I am sorry that I am not being more helpful but this just does not make sense to me. Any thing else you can give me?
    Thanks for your kind reply, i asked the same question to my NP's & im waiting for their reply.. If i got correct reply means, then i will message you to your id about those details.

    Once again thanks, Have a nice day

    Regards,
    Soundar

  7. #27
    Default
    What if it is two visits in a nursing home. Both doctors are from the same clinic but one is a Mental health and the other a Family doctor. Would we use the prolonged services codes or a modifer. Both are billing 99308.

    THanks,
    Emily

  8. Default
    They are different specialties so each codes their own services. Would also expect the DX to be appropriate for their specialty

  9. Default E/M done same day with procedure done later that day? what modifier
    Hi,
    My physician did a consult in the ER at 2:30 in the a.m. Pt was later admitted that same date and my physician came in to place a chest tube. In this case, would I add modifier 59 to the chest tube placement. I thought about the 25 modifier but they were not at the same session.
    Thoughts please
    right now I'm thinking 99284
    32551-59?

    Thank you,
    Marci

  10. Default same day, different procedure, different surgeon
    What about for facilities? We have an ENT seeing a peds pt in the morning to do one procedure. The patient is then seen by the Ortho for a separate. They are scheuled on the same day so the peds patient does not have to go under twice. Can we bill separately for both procedures or would they count as multiple? Remember- different specialties and different surgeon. No assisting or other communication between the two.
    Thanks!

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