Author Topic: same day  (Read 1886 times)

margemib

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same day
« on: July 09, 2009, 02:36:56 PM »
Hi Michele,
I spoke to a women in a Mental Health office today, and asked me for advice.
The Dr. see's people with addictions and sometimes in the same day he may see a patient first and later the parents,
and in some cases he may see the patient two times in a day because of a emergencey and she said should she use a 59 modifier on the first or second procedure, and should she use a modifier on a extended visit because they are not getting paid.
and sometimes he uses a 99058 for emergencies.
margemib
Margie Finlay CMRS

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Re: same day
« Reply #1 on: July 09, 2009, 05:20:03 PM »
Carriers will not pay for two sessions in one day, you can bill a family session (w/out patient) and individual, but the patient cannot have two sessions in one day. Also the authorizations should tell you which codes they will reimburse.
Linda Walker
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margemib

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Re: same day
« Reply #2 on: July 09, 2009, 05:24:20 PM »
does that go for a emergency also, say he saw a person in the morning and later that day they had a emergency and had to be seen?
Also do you use modifiers in this type of billing?
margemib
Margie Finlay CMRS

Michele

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Re: same day
« Reply #3 on: July 10, 2009, 06:45:51 AM »
They will most likely deny.  You can appeal, but if the policy states they only allow 1 session per day, they won't really care if it was an emergency.  :(  I know it doesn't seem right, especially to the dr, but they are not looking at the patient, they are looking at the policy, and it is black and white (literally).

There really is no modifier that will help much.  I would probably put the 59 but I don't think it will matter.

Michele
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margemib

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Re: same day
« Reply #4 on: July 10, 2009, 08:13:29 AM »
thanks for the advice.
do you think modifier 76 repeat procedure may help?
margemib :(
« Last Edit: July 10, 2009, 08:18:52 AM by margemib »
Margie Finlay CMRS

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Re: same day
« Reply #5 on: July 10, 2009, 10:40:17 AM »
A modifier will not help. I've NEVER seen any plan pay for more than one mental health visit in a day. Even emergency they will tell you the patient should have went to the ER.   The same goes for even billing an individual and group on same day, they will not pay.
Linda Walker
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Re: same day
« Reply #6 on: July 10, 2009, 10:42:55 AM »
Just to add to that.. In the patient's policy booklet this is stated under mental health and substance abuse treatment or under exclusions, so you can bill the patient regardless of whether it's in network or out of network. sometimes the EOB will state that you cannot, however you can since it's a policy exclusion.
Linda Walker
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margemib

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Re: same day
« Reply #7 on: July 10, 2009, 10:48:46 AM »
Thank you for all the help!
margemib
Margie Finlay CMRS