Wiki Billing under 2 different NPI's and TIN's

[lisak0727]

We have a surgeon who does surgery at a local hospital and then bills under practice A tax id and NPI. He then sees the patient in follow up at practice B using that groups tax id and a different NPI. Can practice B bill for the follow up visit or a new patient since the patient was never seen in practice B office?

 

[thomas7331]

If the practice A that is billing the surgery is billing a global fee, then the surgeon has already been paid for any post-operative care included in that procedure's global period and no follow-up visits should be billed. If, however, the two practices wish to split the reimbursement, then practice A should bill the surgery with modifier 54 for the surgical care only, and then practice B would also bill the surgery with modifier 55 for the post-operative management. This would allow the payer to know that the reimbursement for the surgery itself should be paid to one tax ID and the post-operative care portion would go to another. In either arrangement, no follow-up visits should be billed during the global period unless there are unrelated problems being treated.

 

[SharonCollachi]

Can practice B bill for... a new patient since the patient was never seen in practice B office?

Definition of a new patient does not include place of service.

 

[lisak0727]

Definition of a new patient does not include place of service.

Thank you Sharon for your reply. I am well aware a new patient does not include the place of service. The question was about two different tax identification numbers.

Thank you again and have a great day!

 

[SharonCollachi]

Thank you Sharon for your reply. I am well aware a new patient does not include the place of service. The question was about two different tax identification numbers.

Thank you again and have a great day!

I apparently hit "post reply" too soon. I meant to say:

Definition of a new patient does not include place of service, tax id, corporate structure, etc. It is whether that PROVIDER has seen the patient, face-to-face, working anywhere (except for a locum tenens situation, then the provider is treated as if he is the provider he is filling in for).