GretchenC123
Networker
I am doing a bill audit for claimant and she was seen by two different providers on the same day for the same complaints. One is an orthopedic and one is a pain management/interventionalist. Is this allowed?
It’s fine, and in fact very common, for a patient to see two or more providers of different specialties on the same day, even for the same complaint or condition. Providers with different training and skills often need to work together as a team on a patient’s problem, and both may need to evaluate the patient.It's not the new or established that I am wondering about. It's the billing for two different MDs in the same clinic on the same day. I am not a coder.
Thank you!!Hi Gretchy
I think it is possible if for different dx problems...one treated the ortho problem then sent to the pain management clinical provider. Was a pain dx G89 put on claim for interventionalist services ? And the ortho problem dx M54.16 as example?
Well hope this helps you
Lady T
Yes, you guessed it. It is a personal injury claim and we are the 3rd party liability insurance carrier.Yes, this happens commonly in specialty practices. However, I have seen some (rare) payers that won't cover two E/M on the same day even if it is 2 different subspecialties if they have the same Tax ID or group NPI. It depends on the payer. If you are doing a bill audit for a claimant, I am assuming it's work comp? You would have to check your payer rule. I am also assuming it was probably a spine surgeon and a physiatrist that saw the person on the same date? If subspecialties are recognized it would depend on their credentialing but usually these two are different. One is orthopedic surgery of the spine and the other is pain management or interventional pain management.
Medicare info:
"B. Office/Outpatient E/M Visits Provided on Same Day for Unrelated Problems 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 documents that the visits were for unrelated problems in the office, off campus-outpatient hospital, or on campus-outpatient hospital setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication eva..."
Okay, then you would have to check the WC/accident/injury rule for your state and your carrier guidelines on same Tax ID/same clinic billing two on the same date. Whether they can do two or have to combine. It's "probably" okay for both. I have only rarely seen where it is not allowed and we had to roll them up into one (with a higher level depending on documentation) or schedule different dates of service. I think in that case though even though the providers were different subspecialities their credentialing had both been done as ortho surgery so technically it was the same taxonomy.Yes, you guessed it. It is a personal injury claim and we are the 3rd party liability insurance carrier.
Thank you so much!!Okay, then you would have to check the WC/accident/injury rule for your state and your carrier guidelines on same Tax ID/same clinic billing two on the same date. Whether they can do two or have to combine. It's "probably" okay for both. I have only rarely seen where it is not allowed and we had to roll them up into one (with a higher level depending on documentation) or schedule different dates of service. I think in that case though even though the providers were different subspecialities their credentialing had both been done as ortho surgery so technically it was the same taxonomy.
It's probably Dr. Spine Surgeon saw them first and there was no surgical intervention needed so they referred over to Dr. Partner Pain Management?