Wiki cpt code 99356

[green69elephant]

Hi, I need help with cpt code 99356. I have one provider billing cpt code 99223 and another provider billing the add on code 99356. The provider billing the add on code is saying he did the rest of the work with the patient when the shift changed on the floor. I need to know if this is appropriate coding, or should the second Dr. be billing something like a 99231?

 

[SharonCollachi]

Are these two providers of the same group and same specialty?

You cannot bill a 99356 by itself, as it is an add-on code.

Medicare states, "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless those services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level. Both Initial Hospital Care (99221-99223) and Subsequent Hospital Care (99231-99233) are "per diem" (per day) services and may be reported only once per day by the same physician or physicians of the same specialty from the same group practice."