Results 1 to 6 of 6

E/m by different providers under different specialties

  1. Default E/m by different providers under different specialties
    Medical Coding Books
    I am receiving denials from United Healthcare for inpatient subsequent E/M services by two different physicians of two different specialties under our multi-group practice. The insurance is stating I need a modifier. I have never used a modifier on an E/M code and do not feel a 77 modifier is appropriate. Has anyone came across this issue or have any idea what modifier is appropriate. Any help is appreciated

  2. #2
    Location
    Lauderdale Lakes
    Posts
    203
    Default
    When I worked for a multispecialty group I just called the insurance and explained to them that two different specialty's saw the patient and there should be different dx. There is no modifier to use. They should just reprocess the claim.

  3. Default
    Thanks so much, I tried that and they will reprocess the claim.

  4. #4
    Default
    We have this same issue with Humana mostly. I don't recall having an issue with any other insurances in our practices. And they fight with us on adding a 24 modifier when it is after a surgery. It's very frustrating to have to call them on every claim!

  5. #5
    Location
    Loma Linda
    Posts
    92
    Default Its as if you were reading my mind... LOL
    We have been having the same issue with UHC minus the modifier. Two providers sam e day same specialty that really are not in the same specialty. They keep saying our issue is because several of our subspecialists are also boarded in IM. So we are being denied because our MD's are boarded more than once... LOL!! We can't be the only multispecialty group with this happening. We have their subspecialties first and everything and we have to call on everyone to have them "REPROCESS" the claim. OBSURD!!!

    Thank you for allowing me to share/ vent.

  6. #6
    Default
    Quote Originally Posted by amsmith View Post
    We have been having the same issue with UHC minus the modifier. Two providers sam e day same specialty that really are not in the same specialty. They keep saying our issue is because several of our subspecialists are also boarded in IM. So we are being denied because our MD's are boarded more than once... LOL!! We can't be the only multispecialty group with this happening. We have their subspecialties first and everything and we have to call on everyone to have them "REPROCESS" the claim. OBSURD!!!

    Thank you for allowing me to share/ vent.
    I understand! Thanks for letting me vent as well!

Similar Threads

  1. Looking for experience coders for the following specialties:
    By anelson30 in forum Employment General Discussion
    Replies: 0
    Last Post: 12-28-2012, 12:47 PM
  2. Specialties
    By Cindyev67 in forum E/M
    Replies: 2
    Last Post: 08-17-2012, 08:02 AM
  3. Same provider has 2 specialties.
    By 1abbynskye in forum Compliance General Discussion
    Replies: 1
    Last Post: 07-20-2012, 01:36 PM
  4. Inpt : Providers completing visits for former providers
    By Chrisd in forum Billing/Reimbursement
    Replies: 1
    Last Post: 12-02-2011, 10:29 AM
  5. specialties
    By kempistyj in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 09-24-2010, 12:19 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.