Modifier???

[medauthor]

Ok guys, my turn to ask a question to anone who may know it    I know there is modifier 77 for repeat procedure by another physician...but does anyone have a recommendation on a modifier on therapy billing if 2 therapists see the same patient in one day and the ins pays one and denies the other?

Thanks for your help 

[Michele]

Are the two therapists in the same group?  (Using the same billing NPI & EIN?)

[PMRNC]

Michelle, the only carrier I know who would pay that is Horizon BCBS..They told me to bill it as two claims but this was an extenuating circumstance, the woman got up from the session a few min early and announced she wanted someone else at that moment. Most of the plans I've seen will actually state no more than one therapy session per day.

[medauthor]

Thanks Linda,

It was actually BCBS of Illinois...

[PMRNC]

Michele, is there an extenuating circumstance? Did you get auth? I would say you need to get an auth and it's going to depend on the circumstance, generally most plans mental health provisions don't allow for 2 visits in one day, regardless if it's a different provider/group. I have a practice with both a psychiatrist and an LCSW and if a patient goes to the psychiatrist on same day as the therapist, the only way the carrier will pay it is if it's a simple Med Check (M0064)
And we have to have both providers authorized along with services.

[Michele]

Yeah, that would be wierd anyway, going from one therapist to a different group in the same day, or the same time period for that matter unless you were switching.

I would say there must be an explanation as to why the patient saw two therapists in the same day.  I would send in a written appeal (if the auth would cover both visits) explaining the reason the patient needed to be seen.  It's really the only option.  I'm not aware of any other way to indicate it.  Even if you use the 77 modifier, they will want to know the circumstances, they most likely wouldn't just allow with the 77 modifier.

Michele