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Modifier???

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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.

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