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Thread: Modifier for two visits on same day

  1. #1
    Join Date
    Apr 2007
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    Default Modifier for two visits on same day

    Hi,
    Im working for NP's , i have a doubt in modifier.. If a patient is visiting two times on same day to different NP for two different reason means which modifier is suitable to bill both? i tried to bill it with 27 for one visit but medicare denies it.If it is same NP means we can use 25, please tell me what modifier for two unrelated visits on same day to two different NP's?

    Please help me to sort out this problem...

    Thanks,
    Soundar

  2. #2
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    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.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Adirondack Chapter of Professional Coders, Glens Falls, NY
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    I don't beleive there is a modifier, Medicare should pay both claims as long as there are two different doctors and two non-related diagnoses. I have had Medicare pay for same day claims under these circumstances.

  4. #4
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    If the docs are in the same specialty in the same tax ID, I have never had any payer including Medicare pay for 2 visits even if dx is different. If different tax Id then fine, If different specialty, then fine. I think it depends on what type of circumstances she has.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5

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    Have you looked at the 76 modifier for office visits

  6. #6
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    You cannot use the 76 modifier on OV codes.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
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    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

  8. #8

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    The reason I ask - in the Medicare E&M Services Part B published Sept 2009, under the heading Physicians in Group Practice..... it states If more than 1 E/M service provided on the same day by the same physician or more than one physician in the same specialty or group for unrelated problems you can use the 76 modifier. Hope this helps

  9. #9
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    Can you provide this link? The guidance I provided comes straight from CMS...

  10. #10
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    I am with Rebecca, Thank You for the reference, I was looking thru my database for the same one you posted. The 76 modifier is not for use on E&Ms and does not make sense, for if the patient returns on the same day for an unrelated issue then it would not be a repeated service. I too would love to be able to see this from CMS.

    Debra A. Mitchell, MSPH, CPC-H

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