Forum - Questions & Answers

Mar 9th, 2011 - Juli

Evaluation and Management Modifier

One of our E&M claim denied by insurance company as duplicate claim. When we followed up with the carrier we got an information that another provider had billed this very same claim. and Rep adviced that we can resubmit the claim with an appropriate modifier so that it can get re-processed.
Is there any particular modifier for this case. I checked Modifier 76 but we can't append this modifier with E&M Service. I need an advise to solve this issue

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Mar 9th, 2011 - jschmutz   323 

Evaluation and Management Modifier - Need more info

What was the E/M service that was billed?

Was the other provider that reported the other E/M service part of your same group practice?

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Mar 10th, 2011 -

Evaluation and Management-Need more info-Hospital follow ups

Thank you Ischmutz for your attension..All were hospital follow ups. ie the CPT® 99233/99232 And the other provider is not a part of our group..Can you help me..

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Mar 10th, 2011 - jschmutz   323 

Evaluation and Management - subsequent visit

Do you know what the other providers speciality is, or what the diagnosis was that he was treating and reported on his claim?

What is your providers speciality and what is the diagnosis that he treated and reported on his claim?

If another provider also reported subsequent visits for the same diagnosis as your provider the insurance MAY be denying because of that, especially if the other provider is of the same speciality. There is no reason why two different providers need to follow and treat a patient for the same reason/diagnosis.

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