Wiki E/M Visit

[peeya]

I need help with a situation in the office

There are two cardiologists with seperate tax id's involved in this situation.

Cardiologist#1 sees the patient & refers him to cardiologist#2 for pacemaker / ICD implants.

Cardiologist#2 sees the patient on the same day & bills for a consult/new patinent visit.

My question is that is there any way Cardiologist#2 will get paid for the visit?

 

[ewinnacott]

Is there transfer of care involved? Is #1 sending patient to #2 and since the patient is getting the pacemaker and implants from #2, #2 will be taking over care of the patient. According to what I've read #2 cannot bill a consult if transfer of care is involved.
Here is what I found from the AMA website:
Transfer of care is the process whereby a physician who is providing management for some or all of a patient’s problems relinquishes this responsibility to another physician who explicitly agrees to accept this responsibility, and who, from the initial encounter, is not providing consultative services. The physician transferring care is then no longer providing care for these problems, though he or she may continue providing care for other condition(s) when appropriate. Consultation codes should not be reported by the physician who has agreed to accept transfer of care before an initial evaluation but are appropriate to report if the decision to accept transfer of care cannot be made until after the initial consultation evaluation, regardless of the site of service. (CPT 2010 Professional Edition, page 4).

 

[ewinnacott]

Is there transfer of care involved? Is #1 sending patient to #2 and since the patient is getting the pacemaker and implants from #2, #2 will be taking over care of the patient. According to what I've read #2 cannot bill a consult if transfer of care is involved.
Here is what I found from the AMA website:
Transfer of care is the process whereby a physician who is providing management for some or all of a patient's problems relinquishes this responsibility to another physician who explicitly agrees to accept this responsibility, and who, from the initial encounter, is not providing consultative services. The physician transferring care is then no longer providing care for these problems, though he or she may continue providing care for other condition(s) when appropriate. Consultation codes should not be reported by the physician who has agreed to accept transfer of care before an initial evaluation but are appropriate to report if the decision to accept transfer of care cannot be made until after the initial consultation evaluation, regardless of the site of service. (CPT 2010 Professional Edition, page 4).

 

[RILEY1959]

This happens to us all the time and yes they both can get paid. What usually happens though is one of them will get denied and you can get the service paid on appeal stating that although both of the providers are cardiologists under the same tx ID#, Dr#1 is the patients primary cardiologist and referred the patient to Dr. #2 because Dr#2 has a sub specialty in Electrophysiology and was asked to see the patient for evaluation for a pacemaker, ICD, etc. And send supporting documentation by both docs showing where the one referred the patient to the other. Good luck!

 

[rthames052006]

This happens to us all the time and yes they both can get paid. What usually happens though is one of them will get denied and you can get the service paid on appeal stating that although both of the providers are cardiologists under the same tx ID#, Dr#1 is the patients primary cardiologist and referred the patient to Dr. #2 because Dr#2 has a sub specialty in Electrophysiology and was asked to see the patient for evaluation for a pacemaker, ICD, etc. And send supporting documentation by both docs showing where the one referred the patient to the other. Good luck!

Smitty is exactly right! We used to have this same issue when I worked for an Oncology group. You'll just have to appeal this when you get the denial!