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ED services by EM specialty code and OBS/ Admission by IM/EM specialty code


Best answers
Hi all,

Does any one know how does Medicare process claims for physicians who are dually boarded, for example, we have a physician that is an internal medicine and emergency medicine ( these are two different specialty codes on the taxonomy crosswalk) . The application submitted had the internal medicine as the primary specialty selected.
So if we submitted a claim for a in patient admission ( 99221-99223) he is practicing as an IM provider. How ever, there are situation in which the same patient was seeing in the ER by a physicians who is board certified in emergency medicine for ED.

My question: are we allowed to bill for both service ( ER visit and admission) ? I know for a fact that if these two physician would be practicing under the same specialty we should only bill the admission but in this case the admitting MD is practicing under IM .

I have to clarify that the IM/EM has admitting privileges but will Medicare consider the secondary specialty code selected or do they base everything on the primary specialty?

Thanks every one


True Blue
Best answers
Our Medicare carrier uses the primary specialty that is selected on the Medicare enrollment form in claims processing, and I believe that the CMS guidance is that all carriers should do this. In my experience, I have not had much luck with appeals in trying to persuade Medicare that a provider has other specialties that might apply to a claim situation. It's a situation you might want to discuss with your carrier's enrollment department to see if there are any options in the enrollment process that would allow multiple specialties to be designated?