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Two e/m same date of service same specialty

  1. #1
    Default Two e/m same date of service same specialty
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    My employer recently took over the ED billing for the physicians. We have now began getting denials for the ED e/m against the H&P because both providers are employed by our group and both are considered internal medicine. Has anyone else had this issue? It is obviously billed with two different POS, but the insurance does not look at that. We are going to appeal it, but I was curious if anyone had found a modifier that would work. Considering 59 in the future.

    Thanks

  2. #2
    Location
    Phoenix, AZ
    Posts
    620
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    If they are seeing the patient twice in one day, you need to combine the E/M documentation and bill the highest level met. You cannot bill with a -59.
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  3. #3
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    Quote Originally Posted by cansas View Post
    My employer recently took over the ED billing for the physicians. We have now began getting denials for the ED e/m against the H&P because both providers are employed by our group and both are considered internal medicine. Has anyone else had this issue? It is obviously billed with two different POS, but the insurance does not look at that. We are going to appeal it, but I was curious if anyone had found a modifier that would work. Considering 59 in the future.

    Thanks
    The problem may be your use of codes. Could you give a coding senario to clarify, it would be easier to help give you a response.

  4. Default
    If two internal medicine physicians from the same group see the same pt on the same day only one will get paid. If it were different specialties in the same group seeing the patient for different dx then both would get paid based on the specialty, like Internal med sees for DM and pulmonary sees for COPD.

  5. #5
    Location
    Seacoast- Dover New Hampshire
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    609
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    We put a 27 modifier on the 2nd E&M.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  6. #6
    Location
    Louisville, KY
    Posts
    1,101
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    Modifier -27 is only appropriate for outpatient facility charges that appear on the UB, never for physician use--as per CPT.

  7. #7
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
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    We are a CAH, that means an outpatient department of the hosptial. This is why we use it.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8
    Location
    Columbia, MO
    Posts
    12,557
    Default
    yes 27 is for the second facility outpatient charge not physician charge. As every one has stated you cannot on the physician side charge for the office, outpatient visit, or ED encounter on the same day as the Inpatient admit if the two physicians are the same group, same specialty. You will be allowed to charge only one. If it is 2 different physicians I am not sure you can combine the documentation though, I never considered that, only when it is same physician have I done that. I am not certain.

    Debra A. Mitchell, MSPH, CPC-H

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