Using modifier 22

The patient comes in to see the doctor for follow-up of colon cancer. Everything is great, the patient is sent to have her chemo infusion. The doctor bills a 99213 for this visit with colon cancer as the dx.

While getting the chemo, the patient has a reaction to where the supervising must attend chairside. Supervising doc dictates a note, takes care of the problem and everything is subsided, patient continues with treatment. Supervising now bills a 99214 for the reaction to the drugs using the reactions as the primary dx and the colon cancer as the last dx.

I want to bill the 99213 for the office visit with colon cancer dx and with Dr. A' s name and then bill 99214 for reaction codes (shortness of breath, etc) with a 22 modifier and Dr. B's name attached. (Both docs are the same specialty)

There were extensive issues that called for the supervising doctor to attend chairside, the note clearly showed the problems/issues and what was done to clear up any issues and everything the supervising reviewed. I have never used the 22 modifer with anything other than surgery codes before, but I don't see why we couldn't use it in this situation?

Normally if this happens, we would pick the highest leveled note and bill that out, but I don't feel that is appropriate or "fair" to the other doctor. I have tried this on one claim to Medicare, and it was paid for, but I am wondering if it was just an oversight on the claims adjustor, or if it is really ok to do this????

using modifier 22

If you look at the CPT definition of modifier 22, you'll see that you may not use it on an E/M service. It is for procedural services.

Two physicians, same group, same specialty: bill and be paid as if they were one physician.

Two E/M's in one day must be unrelated (manual below.) Even with a second diagnosis, this is hard to make the case that they were unrelated. You could try. With physician compensation based on RVUs we do try to be fair to all physicians and assign them the codes for the services they did. But, sometimes, they perform a service that can't be reimbursed. We can't solve it.

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).