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Marina Posted Wed 12th of July, 2017 13:53:53 PM
A patient was seen in our office and we billed an E&M code. Patient was also seen in another Drs office on the same day and they apparently billed for an E&M code as well. Our claim was denied for this reason. What modifier can we bill with to have our claim paid? We are a specialty office and the patient was evaluated for a separate reason.
SuperCoder Answered Thu 13th of July, 2017 02:27:23 AM

Hi,

As per E/M guidelines, two E/M visits should not be billed on the same day, if more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. 

If they are different specialty and for different reasons with different dx, then both the services can be billed by appending modifier -25 in the second service to indicate that second visit is separate and different from the first visit. Also, provide brief explanation of the separateness for both the encounters with clear documentation that should support appropriateness of medical necessity and should warrant for billing both the encounters for the same day.

 

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