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Two E/Ms on same DOS

  1. #1
    Default Two E/Ms on same DOS
    Medical Coding Books
    Can 2 providers of the same practice using the same group NPI bill 2 E/Ms on the same day - one consultation and the other an office visit?

    Any insight will be greatly appreciated.

  2. #2
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    only if one is a different specialty and not for Medicare or any payer following Medicare's 2010 policy on consults,

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Quote Originally Posted by mitchellde View Post
    only if one is a different specialty and not for Medicare or any payer following Medicare's 2010 policy on consults,
    Thanks Debra

    Yes Medicare will not accept consults...

    If they are non-Medicare and of different specialties, do we need a modifier to justify...?

    Thanks again!

  4. #4
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    no there is no modifier, just the documentation to show that the requirements for a consult have been met, the three Rs

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Default Modifier 25?
    Quote Originally Posted by mitchellde View Post
    no there is no modifier, just the documentation to show that the requirements for a consult have been met, the three Rs
    What about mod 25 on the office visit on the same day?

  6. #6
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    No that would be for same physician you have two different physicians so 2 different 1500s.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default Npi
    Quote Originally Posted by mitchellde View Post
    No that would be for same physician you have two different physicians so 2 different 1500s.
    They are using the same group NPI ... ?

    Thanks!

  8. #8
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    but the rendering in box 24J and the sig on line 31 are different for each one. This should be going out as two separate 1500s so there is no 25 modifer to be appended:
    25 modifier significant and separately identifiable E&M by the SAME physician on the same day as a procedure or service.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
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    but the rendering in box 24J and the sig on line 31 are different for each one. This should be going out as two separate 1500s so there is no 25 modifer to be appended:
    25 modifier significant and separately identifiable E&M by the SAME physician on the same day as a procedure or service.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Default 2 e/m's same day different physician
    how about this? Dr. one sees the patient for wrist pain and does a 99212 ov and then sends patient to see Dr. two who has a sub-specialty for hands and completes a 99213 ov. Same day, same tax id, can we bill both encounters? I realize they would both need to provide separate notes, would you have to create two separate encounters also? Also same insurance carrier.

    coderforlife
    Last edited by coderforlife; 01-22-2011 at 02:13 PM. Reason: correction to spelling

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