billing for an office visit ANOTHER QUESTION

[KARREN]

CAN A FAMILY MEDICINE (DO) DR BILL AND OFFICE VISIT CHARGES EACH VISIT, EVEN IF THE VISITS ARE OFTEN.
EXAMPLE 4 TIMES A MONTH

[Steve Verno CMBS, CEMCS]

The family practice provider can render any documented services within his scope of practice.

They can be billed to an insurance company if
(1)  A covered service has been performed that was medically necessary
(2)  Separate procedures that are not bundled per NCCI edits
(3)  Using the appropriate modifier for the CPT group
(4)  The service is NOT upcoded

[PMRNC]

If the visits were documented you bill for services rendered and documented. I'm not sure what your asking. All of the elements of the E/M codes must be in the medical record (documented).

[Pay_My_Claims]

If the visits were documented you bill for services rendered and documented. I'm not sure what your asking. All of the elements of the E/M codes must be in the medical record (documented).

Look at the Map Linda *smile*

[Steve Verno CMBS, CEMCS]

Last post by me:

Mrs. Johnson injured in car accident on Jan 1, 2009 with low back pain.

Visits Dr. Jeckyl on January 1, 2009.  Dr. Jeckyl recommends Mrs Johnson return on January 10.  Visit for January 1 and 10, 2009 can be coded and billed to the insurance company if the service is covered under Mrs. Johnson' benefit plan.

Mrs.Johnson visits Dr. Jeckyl on January 11, 12, 13 and 14 for continued back pain.  Again, the visits can be coded and billed to the insurance company if the visits are a benefit Mrs. Johnson is entitled to receive. If her policy only allows 4 office visits per year, then any visit beyond those 4 days will be denied as non-covered services.  You can bill but the insurance wont pay.  Those visits beyond those days allowed under her benefit plan may have to be paid by Mrs. Johnson.

[Michele]

Are you sure they don't have a limit on the number of PT charges?  If you are sure that they are denying as chiro and you are clearly billing under the DO or MD you will need to appeal.

Michele