Author Topic: 2 E/M on same day - different docs  (Read 2507 times)

mkarnes

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2 E/M on same day - different docs
« on: January 25, 2012, 08:55:17 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.  :-\

DMK

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Re: 2 E/M on same day - different docs
« Reply #1 on: January 25, 2012, 10:29:59 AM »
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.

mkarnes

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Re: 2 E/M on same day - different docs
« Reply #2 on: January 25, 2012, 11:18:57 AM »
Thank you!!

Michele

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Re: 2 E/M on same day - different docs
« Reply #3 on: January 26, 2012, 06:46:55 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?? 
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DMK

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Re: 2 E/M on same day - different docs
« Reply #4 on: January 26, 2012, 10:43:53 AM »
Re-reading the initial post, I missed that!  But if it WAS NOT the same group would both doctors get paid?

PMRNC

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Re: 2 E/M on same day - different docs
« Reply #5 on: January 26, 2012, 01:34:57 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
Linda Walker
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mkarnes

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Re: 2 E/M on same day - different docs
« Reply #6 on: January 27, 2012, 08:42:59 AM »
The two doctors are under the same tax id number but have individual NPI numbers.  This is in an outpatient setting.

PMRNC

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Re: 2 E/M on same day - different docs
« Reply #7 on: January 27, 2012, 06:14:39 PM »
If they are in same practice and it's a group practice, no they won't get reimbursed for both.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com