Article - Billing and Coding: Repeat or Duplicate Services on the Same Day (A53482)

CMS National Coverage PolicyMedicare Claims Processing Manual, Pub. 100-04, Chapter 34Title XVIII of the Social Security Act, 1833(e)Article TextClaims 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/Units10/1/15 71020-26 110/1/15 71020-26-76 1ModifiersFailure 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/Units10/1/15 28010-T1 110/1/15 28010-T3 1Identical 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. ADate of Service CPT Code Days/Units10/1/15 93010-26 1Claim #2 Dr. BDate of Service CPT Code Days/Units10/1/15 93010-26-77 1CPT 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/Units10/1/15 82746 110/1/15 82746-91 1