Wiki Attending Physician vs. Admitting Physician

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cchambersmtz

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When a physician group of hospitalists employed by the same employer are attending a patient who is in the hospital as inpatient, is it correct to submit the entire claim under the Admitting physician? Or, is the claim supposed to be split and billed separately according to each attending physician day for day? Is there any legal documentation to support the correct way to bill under these circumstances? I know that we have to bill as if there is only ONE admitting physician because the physicians are of the same specialty and part of the same group but as for Day to Day billing I am uncertain on whether to bill each daily procedure under the Admitting physician all together or to bill according to the attending physician per day. Our physicians are on schedules so any length of stay past 5 days will have multiple physicians attending the same patient. We have about 25 physicians and 12 hospitals to cover so the scheduling changes quite often.
 
If you're speaking of the claim for the professional services, you cannot bill services of one provider under the name or ID of a different provider (unless it is under a locum tenens arrangement). But you should not have to split the claim - if the providers all belong to the same group, you can bill all services on one claim but with the individual NPI numbers of the various providers in box 24J of the 1500 form.
 
Attending physician vs admitting

Thomas, along the line of attending physician vs admitting. These two doctors are in the same group. patient was admitted to out patient 99235-25 and on the same day and ekg 93010 was read by another physician... and then later the patient had a stress test 93018. Insurance is denying with codes CO-b10 and c0-253 Allowed amount reduced and sequestration reduction. What can be done, any ideas??
 
If the EKG was done first and the stress test was ordered and performed later, then 93010 needs a modifier to separate it as a distinct service - I'd use 59 since none of the X- modifiers, in my opinion, accurately captures this situation.
 
Our practice has a similar situation and even though we bill under the group NPI we split the claims by doctor.

Dr. smith saw the PT
Jan 1
Jan 2
Jan 4
Jan 6

Dr. Jones saw the PT
Jan 3
Jan 5

......and so on. I think that might all depend on your billing software and how it breaks it out but with ours we have to do it manually. Even though the entire claim is billed under the group NPI, you still need the rendering provider ID per each CPT line.
 
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