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two providers, same day

  1. Default two providers, same day
    Exam Training Packages
    We have had patients seeing the doctor who had also seen another provider on the same DOS for the same service (office visit) but we are not getting paid for this service. Does Medicare only pay one doctor on one DOS if the service is the same?

  2. Default
    is this an indication for the use of modifier 77 repeat procedure by another physician?

  3. Default precertification
    if the patient is having an Echo and is out of network how i can check does he need precertification or not.

  4. #4
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by LuluBarr View Post
    We have had patients seeing the doctor who had also seen another provider on the same DOS for the same service (office visit) but we are not getting paid for this service. Does Medicare only pay one doctor on one DOS if the service is the same?
    Are they the same specialty, same practice? Medicare and most payers won't allow two E/M services on the same day by same specialty, same practice.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  5. Default
    no they aren't within the same practice/specialty.

  6. #6
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by LuluBarr View Post
    no they aren't within the same practice/specialty.
    Then they should be allowed, and I would appeal. Patients often see different physicians the same day. We are a large multispecialty clinic and will try to schedule patients the same day for their convenience (especially those from out of town).

    We do, with the multiple specialties, sometimes have problems with "concurrent care" issues when one provider has a subspecialty that isn't recognized by Medicare/other payers - the biggest example is our Hepatologist, who they all insist on seeing as Internal Medicine.

    Good luck,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  7. Default
    apparently, as I find out more, these patients were billed for injections because they were referred by another doctor specifically for the injections only, and then later were referred for pain management. At that point, on the SECOND visit to our office, they were billed for a new patient office visit. Must the new patient *not consult* be done on the day of the first visit, even if it's just for a referred injection?

    I'm calling medicare right now

    Sometimes I use this forum instead of calling medicare myself LOL

  8. #8
    Location
    Evansville Indiana
    Posts
    451
    Default new patient
    Any face to face encounter (service) with the patient would make the next visit established.

  9. #9
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Agreed, since the patient was seen for the injection, the visits after that date are established, not new patients, as outlined in the CPT E/M Services Guidelines.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  10. Default
    Thanks guys, that is what I thought when I saw the new patient visit on the second DOS but me and my supervisor were unsure.

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