Medical Billing Forum

Coding => Coding => : mkarnes January 25, 2012, 11:55:17 AM

: 2 E/M on same day - different docs
: mkarnes January 25, 2012, 11:55:17 AM
One of our general cardiologists saw a patient today and then requested a consultation from our interventionalists/peripheral vascular cardiologist on the same day.  If our interventionalist is listed under a separate taxonomy code, then the consultation should be allowed but what modifier would I attach to the consultation since it is on the same day as the initial E/M with the first cardiologist?  Btw, this is a commercial insurance patient.  :-\
: Re: 2 E/M on same day - different docs
: DMK January 25, 2012, 01:29:59 PM
Shouldn't be a problem.  The 2nd doctor will need to have the UPIN of the referring doctor on his claim.  Both can have an E/M code on the same day, even if it's a new patient code.
: Re: 2 E/M on same day - different docs
: mkarnes January 25, 2012, 02:18:57 PM
Thank you!!
: Re: 2 E/M on same day - different docs
: Michele January 26, 2012, 09:46:55 AM
DMK,  it sounds like they are billing using the same EIN/Group NPI.  I don't think they will allow for two new patient codes from the same group on the same date.  I've been out of things for a few days so maybe I'm missing something?? 
: Re: 2 E/M on same day - different docs
: DMK January 26, 2012, 01:43:53 PM
Re-reading the initial post, I missed that!  But if it WAS NOT the same group would both doctors get paid?
: Re: 2 E/M on same day - different docs
: PMRNC January 26, 2012, 04:34:57 PM
I believe they would as long as it wasn't inpatient, but if they are in the same group (same NPI) they will not receive reimbursement for both
: Re: 2 E/M on same day - different docs
: mkarnes January 27, 2012, 11:42:59 AM
The two doctors are under the same tax id number but have individual NPI numbers.  This is in an outpatient setting.
: Re: 2 E/M on same day - different docs
: PMRNC January 27, 2012, 09:14:39 PM
If they are in same practice and it's a group practice, no they won't get reimbursed for both.