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same day

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margemib:
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

PMRNC:
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.

margemib:
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

Michele:
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

margemib:
thanks for the advice.
do you think modifier 76 repeat procedure may help?
margemib :(

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