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2 Inpatient Consults by 2 different Specialties

  1. #1
    Default 2 Inpatient Consults by 2 different Specialties
    Clearnace Sale
    I have a dilemma with a commercial insurance carrier in regards to a denial we keep receiving for 2 different specialists providing consults on the same day. I work for a Multi-Specialty Group and we had a General Surgeon and a Gastroenterologist perform consults on the same day. The General Surgeon has been paid, the denials all revolve around the GI Specialist. At first the insurance carrier denied the GI doc as a "duplicate" charge. We appealed with consultatoin notes from the hospital and this time we received a denial stating that we need to "submit a revised claim form with the accurate modifier information."

    We can not figure out what modifier the carrier may be asking for and they are not offering any suggestions. After doing some research on the internet, I have very few reliable sources. The one I did find suggested using HCPCS modifier AF - Specialty Physician.

    Does anyone have any suggestions?

    Heather MacPherson, LPN, CPC, CPC-H

  2. #2
    Capital Coders, Columbia, SC
    Do your two specialists share the same tax ID number? All physicians under a single TIN are generally viewed as one physician in the eyes of insurance carriers. If your physicians are under the same TIN, and both saw the patient on the same day for different problems, there shouldn't be any problem. However, if they both saw the patient on the same day for the same or related problem, the ins co. sees this as a duplicate charge. Unfortunately, the quick remedy to this is to combine the E/M services of both physicians and bill as a single E/M charge. They will have to divide their reimbursement on the back end. The not so easy fix is to obtain separate tax ID numbers.

    Bill Hale, CPC

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