# Billing 2 visits for same patient on same day by 2 providers for different problems



## DebbLord (May 23, 2019)

Good afternoon,
I am in need of some help, as there is a lot of confusion when searching for the correct answer.
I work for an Orthopedic office where we have an Orthopedic surgeon and a DO.  Our MD provider saw a patient in the morning for his shoulder, then the patient came back in the afternoon to see our DO for an injection in his hip.
When researching how to bill both visits, I came across several different answers. The patient has Medicare and it stated that two E/M visits cannot be billed in the same day UNLESS the patient was seen for different problems. Another answer (from 2008) stated to append modifier 76 on the second visit, which was done by our DO.  My billing software is stating that Modifier 76 is not appropriate.
Do I bill them both and not append any modifier aside from the 25 modifier for the afternoon visit? Or would I append a 24 modifier along side of the 25 modifier, so show that the second visit is for a completely different problem than the first visit?
I also saw that I should combine the office notes for each E/M and choose the appropriate level to summarize both visits.
Thank you for any help any of you are able to give for this.
Debb


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## sarab86 (May 23, 2019)

Did the DO in the afternoon bill an E&M? If so, I have never seen Medicare pay 2 E&M on the same day by the same specialty even if they have different DX. If that is the case I would recommend you bill out the DO E&M with mod 25 and the inj, hold the MD claim for 1 week to allow Medicare to receive the first claim. Then bill out the MD claim with modifier 24. You may still not get paid for the MD but it is easier to appeal 1 claim rather than have to work both. If you send them both at the same time Medicare will pay the lowest claim(the MD).


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## DebbLord (May 23, 2019)

Thank you.
I billed them out with the MD billing the E/M at a higher level and the DO doing the injection.  I worked for EVMS Otolaryngology in Norfolk Virginia, and we had 10 providers that all did different parts of the head and neck. When they would see a patient and send them to another provider in the same day, I could only bill one provider, unless one did a procedure. Then I billed the office visit under one provider and still appended modifier 25 to the office visit, then billed the procedure under the second provider, but they were being seen for the same problem. That is how we did it for the allergy patients as well, when they saw the provider and the nurse to get their allergy medication injected in the same day.  I just was not sure how it was billed in the orthopedic environment, because here, they see the different providers for different parts of the body.


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