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E&M and Diagnostic Test different providers

  1. Default E&M and Diagnostic Test different providers
    Medical Coding Books
    Hi all,
    wondering if I can get some help or if someone has a general letter for this one. I've got an insurance company trying to take money back on about 5 patients. All 5 of these patients had an Office Visit and an ETT on the same day, both performed by SEPARATE providers in our group. The insurance paid but now they are retracting their money for the E&M stating that these are not allowed on the same day.
    Now, I know that if they were done by the same provider then I would have to append the 25 modifier, however, these are being done by 2 separate providers.
    Has anyone had this issue lately?
    If you have some good verbiage you'd like to share, i'm all for it.

  2. #2
    Location
    Richardson, TX
    Posts
    822
    Default
    Quote Originally Posted by cvand1972 View Post
    Hi all,
    wondering if I can get some help or if someone has a general letter for this one. I've got an insurance company trying to take money back on about 5 patients. All 5 of these patients had an Office Visit and an ETT on the same day, both performed by SEPARATE providers in our group. The insurance paid but now they are retracting their money for the E&M stating that these are not allowed on the same day.
    Now, I know that if they were done by the same provider then I would have to append the 25 modifier, however, these are being done by 2 separate providers.
    Has anyone had this issue lately?
    If you have some good verbiage you'd like to share, i'm all for it.

    Yes BUT do those providers share the same Tax ID#? All our Cardio docs are under the same number so we have to make sure we utilitze the 25 when and where appropriate.
    Julie Graham, BA, CPC, CCC

  3. Default
    Yes, we have the same Tax ID. We've never had this problem. We don't even have it with Medicare. Also, these ETT's were done with a Nuclear Scan that was done on the same day. Seems odd that they are only doing this because of the 93015.

  4. #4
    Location
    Phoenix, AZ
    Posts
    620
    Default
    As Julie stated, you need to bill with -25 on the E/M.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  5. #5
    Default
    Be carefully when adding a -25 modifier to the OV! If the patient comes in for an office visit and all you do is review just to confirm and document the patients current condition before performing the test, then the office visit should not be billed. The only rationale to bill both and get paid is if the office visit is over and above, and unrelated to, the performance of the stress test. A few examples are if the patient is diagnosed with a new problem or if an abnormality in the stress test requires additional decision making. The office notes have to stand alone for the new diagnosis and the history, exam and medical decision making components have to be documented.

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