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Patient seen by 2 providers on the same DOS for 2 separate problems

Julie Posted Mon 01st of September, 2014 08:41:34 AM

Hello

What is the correct way to bill for a patient who was seen by two of our providers on the same day for two separate problems? We are a pain management clinic.

Provider #1 (MD) saw the patient for a failed back syndrome, and future removal of a dorsal stimulator. This will be a hospital procedure done by our MD.

Provider #2 (NP) saw patient for a lengthy discussion of medication management/changes, and treatment of knee OA.

Both providers charged 99214, and the notes are adequate for that level x 2.

What modifier is appropriate in this situation, and which claim do I put it on? Do I need to bill one first, and then bill the 2nd later with the modifier? Or is it appropriate to bill them as one visit as a high level consultation code - and would I assign both providers to the one line consult charge?

Thanks in advance for your help!

SuperCoder Answered Tue 02nd of September, 2014 07:37:50 AM

Thank you for your question.

There is not a modifier that separates the two visits from one another. If both visits are billed, one would be denied. Please see the Medicare guidelines below:

30.6.5
-
Physicians in Group Practice
(Rev. 1, 10
-
01
-
03)
Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. 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. Instead of billing separately, the
physicians should select a level of service representative of the combined visits andsubmit the appropriate code for that level.
Physicians in the same group pvractice but who are in different specialties may bill and be paid without regard to their membership in the same group.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

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