Billing two office visits, two different providers, same office, same day

We have a patient who called to schedule a sick visit for bronchitis and a puncture wound to his hand. He was seen by a NP, given script for antibiotic for the bronchitis and a Tetanus shot for the puncture wound. Done, simple...E/M, Tetanus billed...

After being seen by the NP, he requested to see his Primary Physician in the same practice as he wanted to get a script for a medication refill of his controlled substance and discuss his ongoing shoulder problem and carpal tunnel as well as some other issues. His Primary Physician sometimes gives him injections for the shoulder and carpal tunnel, the NP does not.

Before he could be given the medication refill, he had to have a Urine Toxicology done.

He was then seen by the Primary Physician, given an injection into his shoulder and his carpal tunnel and also given his medication refill.

Why he was allowed to schedule two different appointments in this manner has yet to be determined! That is another story for another day!

Are we allowed to bill E/M for both visits? There are separate diagnoses, unrelated to each other. Modifier 25, 59, or both?

re: Billing two office visits, two different providers, same office, same day

You can not bill for 2 visits for the same practice with the modifiers. That would not be appropriate. You may however look in to seeing if you can combine the NP service and the provider service and bill for a higher level office visit provided the documentation supports it.