Consults

grandmacora

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I work for a orthopedic clinic we have back doctors, shoulders, knees, hips and hands. They are all board certified orthopedics surgeons with the same tax id #. My question is can a knee doc send a pt to see the hand surgeon and the hand doc bill a consult???? Thanks
 

purplescarf23

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As long as all the requirements are met to bill a consult, it should not be a problem. I have a general surgery group that does this, as well as an ortho group. They all have sub specialties and refer to each other. We have the same tax ID but they do have separate NPI #'s for say breast surgeon vs colorectal surgeon. We have not had a problem billing these. Hope that helps.

Kelsey, CPC, CEMC
 

melzinser

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Do they get paid 1st time?

Kelsey, I am curious because we have a similar situation within our orthopedic practice - providers with same tax ID but different areas of specialty (spine, foot & ankle, knee, total joint, etc.) but when we bill consults as you describe, we have to fight for payment from most commercial payers. We have considered just billing established patient office visit codes instead. It is easier to support a level 4 est. pt. OV (meeting 2 out of 3 criteria) than the consult code (needing 3 out of 3 criteria) and we don't spend time or money having to appeal denied claims.

I understand the "correctness" of your coding, but do have any difficulty getting paid on the initial claim submission?
 
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