Marilyn Posted Wed 23rd of January, 2019 01:39:03 AM
Patient seen same day, morning and am. Two different place of service. How can we get the second visit paid? Is there a modifier that can be used
SuperCoder Answered Thu 24th of January, 2019 04:34:47 AM
If patient is established and has been seen for the same reason, then out of E/M codes 99212, 99213 and 99214 can be billed for both the visits, because as per guidelines these three codes can be billed twice (each code has 2 units) for same date of service. On the other hand, if patient is new, then first service can be billed from office visit 99201-99205 code series for new patient and second visit can be billed from established patient code series 99211-99215 with medical necessity support. However, if patient is seen for different conditions in different place of service, then it can be billed directly with support of medical necessity. With another scenario, if patient if seen in the morning and physician decided to perform any procedure then modifier 57 (Decision for surgery) can be used with the E/M code. Modifier 25 also can be used with the E/M code, but medical documentation has to justify performing the separate E/M service. The patient’s condition may warrant the same provider performing a separate E/M service and another service or procedure on the same day. A provider may also render two E/M services to the same patient on the same day. Append modifier 25 to the second E/M service to prove that it was separate from the first E/M.
So, it is suggested to check the scenario under which patient has been seen, and bill accordingly.
Hope this helps!
Marilyn Posted Tue 29th of January, 2019 13:03:58 PM
The procedure codes used are "90837". Seen twice, morning and afternoon, same day but different locations. What modifier can be used?
SuperCoder Answered Wed 30th of January, 2019 07:29:26 AM
Units of the CPT 90837 are 2, means can this code can be billed twice for same date of service. However, if the provider performs procedures together, and the documentation supports the rationale for performing them, you can append modifier 59 to the second procedure when billing together for same DOS with different POS.
Modifier 59 tells the payer that the provider does not ordinarily perform the procedure with another procedure for the same patient, on the same day, by the same provider. The procedures would normally be bundled under one code. In order to report modifier 59, the provider’s documentation must support a:
- Different encounter or session
- Different surgery or procedure
- Different organ system or body site
- Separate incision or excision
- Separate lesion
- Separate injury
Also, make sure your second procedure support the medical necessity with the proper diagnosis code and reason for visit.
Hope this helps!