Get Effective 01-01-11

The para states that: as for all other E/M services except where specifically noted, the Medicare Administrative Contractors (MACs) may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician ...

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.

Under the so-called “multiple procedure rule,” Medicare pays less for the second and subsequent procedures performed during the same patient encounter. There are several ways in which reductions may be taken, as indicated for each CPT® code in column “S” of the Physician Fee Schedule Relative Value file.

Patients often schedule two medical appointments on the same day with physicians of different specialties. It's convenient for them. It saves travel time. It may mean the patient or a family member only needs to take one day off work.

Three-year rule: The general rule to determine if a patient is new” is that a previous, face-to-face service (if any) must have occurred at least three years from the date of service. Some payers may have different guidelines, such as using the month of their previous visit, instead of the day.

Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session.

Physicians shall use POS code 11 (office) when services are performed in a separately maintained physician office space in the hospital or on the hospital campus and that physician office space is not considered a provider-based department of the hospital.

Medicare pays 80% of the approved charge. Either the patient or supplemental insurance pays the remaining 20% co-payment.