Billing and Coding: Repeat or Duplicate Services on the Same Day

Claims for multiple and/or identical services provided to an individual
patient on the same day, may be denied as duplicate claims if Palmetto
Government Benefit Administrators (GBA) cannot determine that these services
have, in fact, been performed more than one time. Filing claims properly the
first time will reduce denials.  
  
Many providers and billing departments re-file claims without allowing
sufficient time for the original claim to process. Refilling a claim before
the original claim has processed can cause further delays in processing and
payment. One submission of a claim 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 interactive voice response (IVR) or the online provider
services (OPS) for an electronic claims status inquiry function.  
  
A denial should be expected if identical duplicate services are submitted for
the same date of service. Should a correction of a previously submitted claim
be needed, do not submit the correction as a new claim. Palmetto GBA can
reopen claims for minor corrections. Claims denied as "not medically
necessary" cannot be reopened at the claims processing level after a denial
for that reason has been issued. An appeal (redetermination) may be requested
for services denied as "not medically necessary" or for other issues beyond
minor corrections. Additional documentation in support of the service(s)
provided should be submitted with the appeal request. Please refer to the
Medicare Claims Processing Manual, Pub. 100-04, Chapter 34 for detailed
instructions regarding a reopening vs. an appeal.  
  
To ensure correct processing of your claim, please consider the following:

 Submit services on one claim using the Days/Units fields and appropriate
modifier.  
 Please be sure the correct modifiers are submitted on the claim when
multiple identical services are submitted in order to identify these services
as separate services and not duplicate billing of the same service. A denial
can be expected if the same service is submitted on more than one claim or
more than one claim line for the same date of service.  
  
Example:  
The patient receives two chest x-rays on 10/1/15 which are 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:  
  
CPT Code/Modifier Days/Units  
10/1/15 71020-26 1  
10/1/15 71020-26-76 1  
  
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, as
in the above example, the first service should be submitted without the -76
modifier and the repeat service(s) should include the -76 modifier(s).  
  
Site Modifiers:  
Use site modifiers (e. g. RT, LT, T1) as appropriate.  
  
Example:  
The 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/Modifier Days/Units  
10/1/15 28010-T1 1  
10/1/15 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.  
  
  
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 10/1/15. 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  
10/1/15 93010-26 1  
  
  
Claim #2 Dr. B  
  
Date of Service CPT Code Days/Units  
10/1/15 93010-26-77 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/Modifier Days/Units  
10/1/15 82746 1  
10/1/15 82746-91 1