Forum - Questions & Answers

Oct 24th, 2015 - eannie13

Blling e&m code same day different providers with in the group

we have 34 offices and a patient had gone to one office and was seen by a nurse practitioner and then had gone to one of our other offices and had seen one of our PCP doctors for a different dx reason. Can we bill 99213 twice by adding a modifier 25 and 76?????

Thank you
Anne

Oct 27th, 2015 - Codapedia Editor 1,399 

re: Blling e&m code same day different providers with in the group

Typically, one E/M service per specialty per day is paid.

Was the second completely unrelated? Here's what the CMS manual says:

B Office/Outpatient E/M Visits Provided on Same Day for Unrelated Problems
As for all other E/M services except where specifically noted, carriers may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident).

Good luck,

Betsy



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