AAPC - credentialing the business side of medicine

heatheralayna · #1 01-18-2010, 05:07 PM

Please help!

I thought I had this all figured out.... obviously not

We have a group of cardiologists and we recently added an EP doctor. They all bill under the same tax ID#.

If our cardiologists refer a patient to the EP doctor, is this considered a new patient? We are having a difference of opinions here.

In the hospital, again, our cardiologist sees the patient, then the EP doctor or vice versa the EP does a procedure so the patient is now in a global period and the cardiologist sees the patient for a different dx.

I am getting denials all over the place. Should I even spend the time to fight them? I was told the EP doctor was credentialed as an EP doctor, but the insurance companies don't seem to be seeing that way. Do I need to help them see the light (haha)

I'm sure this isn't a new issue. I so appreciate any help/guidance!

Chanke · #2 01-19-2010, 07:03 AM

um, this may be a dumb question but what is an EP ?

LUCUSCPC · #3 01-19-2010, 09:29 AM

It is my understanding if they are all under the same tax ID#, all Dr's are considered the same practice, thus no consult or new patient for the EP, ....what is an EP?

Marilyn L

LLovett · #4 01-19-2010, 09:53 AM

The issue here is the fact that carriers do no recognize EP as a separate specialty from cardiology. At least I am not aware of any carriers that recognize them.

So as far as I know you would treat them the same as you do all the other cardiologists in your group.

There are times when you might get a consult covered but it would be thru an appeal/review process. The key word here is might.

EP is a subspecialty cardiologist ElectroPhysiology.

Laura, CPC, CPMA, CEMC

Chanke · #5 01-19-2010, 10:20 AM

Quote:

Originally Posted by LUCUSCPC

It is my understanding if they are all under the same tax ID#, all Dr's are considered the same practice, thus no consult or new patient for the EP, ....what is an EP?

Marilyn L

Even with the same tax ID#, if they are different specialties, you can get a new pateint and/or consult. We have several specialties under the same tax ID#- orthopedics, OB/GYN, etc.

mattirehman · #6 01-19-2010, 11:35 AM

When the EP doc sees the patient, it is an established patient. EP is considered the same specialty as cardiology, so it is not a new patient to the practice.

LOVE2CODE · #7 01-19-2010, 11:40 AM

Quote:

Originally Posted by cghanke

um, this may be a dumb question but what is an ep ?

electrophysiology (ep)

dclark7 · #8 01-19-2010, 11:40 AM

This question had me interested so I tried to do a little research. As far as I could find out there is no separate specialty for EP. When a physician is credentialed (with medicare) he/she must list a specialy code, after looking at the Medicare claims processing manual and the the list of codes for specialiteis I found that Cardiology is #06, vascular surgery is #77 and cardiac surgery is #78. There is no sub-speciliaty for EP, therefore your doctor would be considered a cardiologist by the insruance companies and would fall under the same rules as any other doctor in your group. I found this in the MCM section #2207.

Hope this was helpful.

Doreen, CPC

heatheralayna · #9 01-19-2010, 02:14 PM

oops sorry, yes

EP = electrophysiology

it is a subspecialty of cardiology

He calls himself the "electrician" of cardiology. They do the pacer inserts, node ablations, electropsyiology studies, etc.

Last I heard the society of EP physicians was trying to get their own taxonomy # but I have not heard if they have been succussful or not.

Thanks for all your help! I appreciate it.