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2 Visits, 2 different Providers

  1. #1
    Location
    Chicopee, Mass
    Posts
    75
    Default 2 Visits, 2 different Providers
    Medical Coding Books
    I have this scenario: A patient comes in for an E&M visit with a doctor for one problem, and later in the day comes in to see one of our PA's for a scheduled injection for a separate problem. How can I bill this out (he has Medicare)? The 25 modifier does not fit for this situation, but the claims will reject. Any one have some info to help me???

    THANK YOU!!!
    Valerie

  2. #2
    Default
    Quote Originally Posted by Valerie813 View Post
    I have this scenario: A patient comes in for an E&M visit with a doctor for one problem, and later in the day comes in to see one of our PA's for a scheduled injection for a separate problem. How can I bill this out (he has Medicare)? The 25 modifier does not fit for this situation, but the claims will reject. Any one have some info to help me???

    THANK YOU!!!
    Valerie
    Easy - you don't bill an E/M for the PA. It was a previously scheduled injection; therefore, it doesn't warrant an E/M. As long as your rendering NPI's are different, you shouldn't need a modifier. Your doctor's OV claim may deny as incidental to the PA's service, though, so I'd send the claim by paper with records, if that's possible. If not, just make a note on the account to send it for reconsideration if it denies, that way you won't be backtracking to see what the problem was in 30 - 45 days. Hope that helps!

  3. #3
    Location
    Chicopee, Mass
    Posts
    75
    Default
    Thank you, Brandi I was stressing over this all day. I want to bill it out correctly the first time!

  4. #4
    Location
    Ellenville, New York
    Posts
    1,177
    Default Be sure your MAC accepts paper claims....
    if you are going to send records with the initial claim. I used to code for surgeons who used the -22 modifier on occasion and I would need to submit the documentation for support. When I tried to drop the first claim on paper and send the record with the claim, our MAC (NGS) would deny, saying they would only accept electronic claims. When I explained that I knew I would need to send documentation, I was told to first submit electronically, wait for the request or denial, and then send the docs. That was frustrating - only delays payment when I could save a step.

  5. #5
    Default
    MnTwins29
    That's the scenario that we follow. And it can take as long as 2 months to be reimbursed.

  6. #6
    Location
    Chicopee, Mass
    Posts
    75
    Default
    I am sending out both claims- they will be under two different provider numbers. We are going to track it, and if it denies we are going to appeal them with notes. They do accept paper claims. Thanks everyone for all your input!

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