Wiki Same physician Same Day

[cperk]

I need some help please. A question thats been coming up at my group is about coding when a patient is seen multiple times in a day for the same problem. Patient comes in and sees a provider then comes back hours later and sees another provider that is in the same group and they're being seen for the same reason. As far as I know you can't bill two E/M codes on the same date of service for the same diagonsis. Would the second provider just add his notes and append a modifier -25? Please help. Thanks in advance.

 

[sivagurulingam]

My opinion:
We need do bill only one E/M service. We have add together both provider work and bill as a one E/M service.

 

[Leenahz]

I agree with your thinking, cperk. I've worked in a PCP setting where patients have returned for a second visit in one day. I've used the modifier 25 for the second visit. Of course, I've had insurances deny the second visit, but I've always appealed successfully.

Hope this helps

Marlena

 

[teresabug]

From the wpsmedicare.com website under mod 25:
Special situations-
Occasionally two physicians in the same group with the same specialty (but different subspecialties) see the patient on the same day. Medicare does not recognize subspecialties on front-end claims processing. The physician may use Modifier 25 if the documentation meets the definition above. Please submit the documentation when requesting a redetermination.