Wiki ?Modifier for multi-speciality group

[sherrod@medexassociates.com]

I bill for a multi-speciality group. On many occassions we have more than one MD within our practice see the same patient on the same day. Most all of the time it is while they are inpatient. When billing E&M codes, is there a correct modifier to justify two physicians within the same group, different specialities, billing with different dx codes, billing for the same patient on the same date? The first claim that hits is paid and the second is denied as a duplicate......

 

[GaPeach77]

The claims should not be duplicating if they are using the proper ICD-9 code. A pulmonary specialist should have the pulmonary ICD-9 code on the claim, while the cardiologist within the same practice should have the cardio ICD-9 codes. You have to put the specific ICD-9 code according to the reason the specialist is seeing the patient. It can be ten different specialitist within the same practice that utilizes the same E & M, but each should have a different ICD-9 code.

 

[mhcpc]

We are having this problem with several carriers. They are pulling from your Tax-ID and not your NPI, they aren't looking at the Taxonimy code either.

 

[Evelyn Kim]

there is no specific modifier for this situation. the best that you can do is to appeal the denial. I would recommend a review of the contract to make sure the verbiage does not exclude members of the same group seeing the patient on the same day.

Also make sure to use the dx code that corresponds to the speciality seeing the patient. This has helped me in the past to successfully appeal this type of denial.