e/m question

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I have a question, please help im getting confused - Patient comes in our office as a brand new patient, sees an sports/med doctor and tells the patient to see our hand specialists, same tax id, can that be billed as a new patient or should that be a consultation? please advise, im getting these questions thrown at me, Isnt a patient new once when billed under the same tax id?
 

mhstrauss

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I have a question, please help im getting confused - Patient comes in our office as a brand new patient, sees an sports/med doctor and tells the patient to see our hand specialists, same tax id, can that be billed as a new patient or should that be a consultation? please advise, im getting these questions thrown at me, Isnt a patient new once when billed under the same tax id?


Most payers base this on NPI registration, not Tax ID. If the hand specialist is registered under a different specialty than the sports/med doctor, then when the patient sees the hand specialist, it will be as a new patient.
 

AmandaBriggs

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I agree with Megan's response. I work in a cardiology clinic and our interventionalists and electrophysiologists have different taxonomy codes. If a general cardiologist sends a patient to one of their partners with a different taxonomy code, then we bill as a new patient as long as they haven't seen a different interventionalist or EP doc within our group in the last 3 years.
 
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The TIN comes into play when you're referring to the "same group". A provider's taxonomy code is what separates the individuals within that group (based off their primary specialty designation). Any other specialties the provider has listed beyond their primary specialty are their "subspecialty". CPT makes the distinction down to subspecialty, but Medicare doesn't follow that guideline. MC only drills down to the primary specialty.
 

KMCFADYEN

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My apologies...
yes, a different specialty would make a difference as long as the insurance that they file to has them contracted as such. I was basing my answer on the experience of coding for an Orthopedic office where there were different sub-specialties but they were only credentialed with insurance as orthopedic so that new patient would be an established patient if referred with in.
 
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My apologies...
yes, a different specialty would make a difference as long as the insurance that they file to has them contracted as such. I was basing my answer on the experience of coding for an Orthopedic office where there were different sub-specialties but they were only credentialed with insurance as orthopedic so that new patient would be an established patient if referred with in.

Sometimes we forget that there are other insurance carriers other than Medicare :rolleyes:
 
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20670 being billed with modifier

Hello I am starting to bill for an orthopedic surgeon and running into cpt 20670 being used multiple times. We billed it as
20670,58
20670 58,59
20670 58,59
20670 58, 59

But insurance denied. Does anyone know how this should be billed? Please help
 

jdibble

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Hello I am starting to bill for an orthopedic surgeon and running into cpt 20670 being used multiple times. We billed it as
20670,58
20670 58,59
20670 58,59
20670 58, 59

But insurance denied. Does anyone know how this should be billed? Please help

This question looks like it should have been posted under Orthopedic rather than attached to an E/M question!

Do you have an OP note to show what was done? For one thing, it looks like this code can only be billed 3x in one day. However, my question is why are you billing it that many times? If it is to remove each screw placed for the same fracture, than you should only be billing this code once. If, for example, the patient had two separate fractures that hardware was being removed from, then you can code the second procedure with 20670-59. If it is within the 90 day global period of the original surgery then you would add the 58 modifier.

An OP note would help in determining what it is that was actually done.

Hope that helps.
 
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