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Which Modifier

Nancy Posted Wed 15th of June, 2011 14:06:55 PM

We have a patient who was seen in the hospital by one of our Hospitalists and then on the same day one of our Cardiologist saw the patient. Both providers billed the same dx. Medicare has denied our Cardiologist claim because both of our providers bill under the same Group Number. After placing a call to Medicare and explaining that each of our providers have different taxonomies and NPIs we were instructed to use an appropriate modifier to show a repeat visit. I am confused as to which modifier they are referencing. Please advise and Thanks for any help in this matter.

Judy kay Answered Wed 15th of June, 2011 17:06:49 PM

Medicare might be referring to either Modifier 77 or 59 - probably the 77. However, I would believe that this should not be necessary - Did you check with Provider Enrollment @ Medicare to see what speciality these physicians were listed under. It might be an error in that both doctors are listed under the same speciality. I experienced this problem in the past with a GI doctor that Medicare had inadvertently entered the GI doctor under IM, and another Medicare application had to be refiled to get this problem corrected. Otherwise, if the Modifier is used Medicare could come back in a few years and recoup their payments under the RAC reviews. Let me know what you find out from Provider Enrollment as I am curious since I went thru a similar situation.

Nancy Posted Wed 15th of June, 2011 17:43:55 PM

Thanks for your answer but 59-modifier is for a distinct procedural service and 77 can't be used with an E/M service. So, I will contact my Provider Enrollment @ Medicare.

SuperCoder Answered Wed 15th of June, 2011 18:21:24 PM

It has been my observation that if multiple E/M codes billed on same DOS to Medicare, one of the E/M code gets denial. It has always been advisable to bill the major part of the E/M with higher level as only E/M performed today to justify the combined effect of E/Ms performed on same DOS.

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