Jurisdiction 1 Part B
(last updated on 10/15/2012)
Repeat or Duplicate Services on the Same Day
Claims for multiple, identical services provided to an individual patient on the same day may be denied as duplicate claims if Palmetto GBA cannot determine that these services have been performed more than one time. Filing claims properly the first time will reduce your need to appeal those denials and improve your cash flow.
Many providers and billing departments re-file claims without allowing sufficient time for the original claim to process. One submission is all that is required. If you have not received payment after 30 days and are concerned about your payment, please use the Palmetto GBA IVR or the Online Provider Services for an electronic claims status inquiry function.
When a correction is needed on a previously paid service, do not submit as a new claim. Palmetto GBA can 'reopen' these claims, but you may request an appeal.
To ensure correct processing of your claims, please consider the following:
Submit multiple, identical services on the same claim. If you submit more than one claim for the same service, you can expect identical services to be denied.
Use the Days/Units Field. Submit services on one claim using the Days/Units field.
The most effective method to ensure timely processing is to use the Days/Units Field and submit all services on one claim.
Example:
Patient receives two chest x-rays on 10/1/12 interpreted by the same physician. The first interpretation is performed at 10 a.m. and the interpretation of the second x-ray is performed at 1:30 p.m.
Submit as:
|
Date of Service |
CPT Code/CPT Modifier |
Days/Units |
|
10/1/012 |
71010-26 |
2 |
Modifiers
Failure to submit appropriate modifiers may result in delay of payment or denial of service(s). When a modifier is used to indicate a repeat service, the first such service should be submitted without the modifier and the repeated service(s) should include the modifier.
Site Modifiers:
Use the appropriate site HCPCS modifier (RT, LT, T1, etc.), if available.
Example:
Patient receives a percutaneous tenotomy on the second digit and the fourth digit of the left foot by the same physician on the same day.
Submit as:
|
Date of Service |
CPT Code/HCPCS Modifier |
Days/Units |
|
10/1/12 |
28010-T1 |
1 |
|
10/1/12 |
28010-T3 |
1 |
Identical services being repeated should be submitted using CPT modifier 76, 77, or 91.
CPT Modifier 76 'Repeat procedure by same physician': The physician may need to indicate that a service was repeated the same day subsequent to the original service. This modifier indicates the difference between duplicate services and repeated services.
Example:
Patient receives three chest x-rays on 10/1/12 by the same physician. The first x-ray is performed at 10 a.m., the next one at 12 p.m., and a follow-up x-ray is performed at 1:30 p.m.
Submit as:
|
Date of Service |
CPT Code/CPT Modifier |
Days/Units |
|
10/1/12 |
71020 |
1 |
|
10/1/12 |
71020-76 |
2 |
OR submit as:
|
Date of Service |
CPT Code |
Days/Units |
|
10/1/12 |
71020 |
3 |
The most effective method to ensure timely processing is to use the Days/Units Field and submit all services on one claim.
CPT Modifier 77 'Repeat procedure by another physician': A physician may need to indicate that he or she repeated a service performed by another physician on the same day.
Example:
Patient receives two EKGs on 10/1/12. The first EKG is taken at 10 a.m. and Dr. A performs the interpretation. The second EKG is taken at 1:30 p.m. and Dr. B performs the interpretation.
Submit as:
Claim #1 Dr. A
|
Date of Service |
CPT Code |
Days/Units |
|
10/1/12 |
93010 |
1 |
Claim #2 Dr. B
|
Date of Service |
CPT Code/CPT Modifier |
Days/Units |
|
10/1/12 |
93010-77 |
1 |
CPT Modifier 91 'Repeat clinical diagnostic laboratory test': It may be necessary to repeat the same laboratory test on the same day to obtain multiple test results. In this case CPT modifier 91 should be used. This modifier may not be used when tests are repeated to confirm initial results due to testing problems with equipment or specimens. Tests that include multiple specimens being collected at different times (e.g., glucose tolerance) should be submitted using the appropriate code for the test and should not be submitted as repeated tests.
Example:
The patient had two folic acid tests performed on the same day.
Submit as:
|
Date of Service |
CPT Code/CPT Modifier |
Days/Units |
|
10/1/12 |
82746 |
1 |
|
10/1/12 |
82746-91 |
1 |
The above information was taken from: