Get Paid for Two Services

November 1, 2005

We are a two-physician OB/GYN practice. We have noticed that when we bill a fetal nonstress test on the same day as an office visit — performed by a single physician — it is almost always denied. However, if Dr. A sees the patient and Dr. B does the fetal nonstress test, can we bill for both and expect reimbursement? We are a group and use one tax ID.

Question: We are a two-physician OB/GYN practice. We have noticed that when we bill a fetal nonstress test on the same day as an office visit - performed by a single physician - it is almost always denied. However, if Dr. A sees the patient and Dr. B does the fetal nonstress test, can we bill for both and expect reimbursement? We are a group and use one tax ID.

Answer: According to Emily Hill of Hill & Associates, if you are not attaching the -25 modifier to the visit, you should. More payers are requiring it even when the other service is considered a diagnostic test; this should help reduce the number of denials when the same physician provides both services. If the claim is denied, you should appeal with documentation. Make certain that you have distinct documentation for both services. You should always bill services under the name of the physician who performed and documented the service. That said, there is nothing wrong with different doctors performing and billing different services, but it may not matter from a reimbursement standpoint since you use a single tax ID and are of the same specialty.