2 visits on same DOS, one w/ peds, one w/ peds sunspecialty


Philo, IL
Best answers
A patient was seen by peds pulmonary on the same day as general peds. Can the two vists be coded? Our claimsmanager is kicking it out stating that 2 visits from the same specialty are being billed. Shouldn't they be allowed to bill since one is a sub-specialty? Do I need a modifier?
Is the pediatric pulmonary physician considered to be a boarded sub-speciality? Is this physician credentialed with the payer specificaly as pediatric pulmonology?

These are the questions that you have to ask before deciding if their both billable on the same day. If so, even under the same tax ID you could bill both but only if the above criteria are met as well as proper requests and medical necessity etc.

Some sub specialites are not considered a true sub specialty by credentialing, boarding, and licensing standards. For example: Urogynecology falls under gynecology even though there are practices dedicated to urogyn. A patient seeing her GYN on the same day as Urogyn will likely only have one claim paid that day. Rheumatology is another one that hits up against internal med etc.

You may still have to appeal one of these claims due to edits applied by the payers ajudication software.

Good Luck!