Wiki H&P & Discharge help

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cbheusman

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I was hoping to get some help with this scenerio:

Dr. Podiatry has an established patient that needs sx. Dr. General ortho does an H&P in the hospital on the same date of sx and then does the discharge the following day. Both MDs are from the same practice billing under the same tax id. I've been told that because they are different sub specialties that this can be billed seperately. I don't think this is correct and was hoping to get some guidance with this. If this is not correct then Dr. General ortho will want documentation to prove it. Can anyone point me to where I might find documentation to show her? (if she's not able to bill this)
Thanks in advance!
Cathy
 
look in the medicare claims processing manual chapter 12 on page 33 or (30.6.5)
the same tax ID has nothing to do with it if they are truely different specialties. i work for a multi-group practice all with the same tax ID but differnt specialties. sorry i cant find the direct link if i do i'll reply again
good luck
chris, CPC
 
cbheusman said:
I was hoping to get some help with this scenerio:

Dr. Podiatry has an established patient that needs sx. Dr. General ortho does an H&P in the hospital on the same date of sx and then does the discharge the following day. Both MDs are from the same practice billing under the same tax id. I've been told that because they are different sub specialties that this can be billed seperately. I don't think this is correct and was hoping to get some guidance with this. If this is not correct then Dr. General ortho will want documentation to prove it. Can anyone point me to where I might find documentation to show her? (if she's not able to bill this)
Thanks in advance!
Cathy
Click to expand...

I've actually had this situation arise, and the same tax id should not be an issue, you may have to appeal the decision at first which is what we have had to do but once we specify that both Md's are of differant sub-specialties it usually fixes the problem, also make sure that your not using the same diagnosis for both physicians make sure they are using distinctive dx for both since one is using their "sub-speciality".

Don't be discouraged if it is denied initially, just have your documentation ready just in case.
 
Chris & Roxanne,
Thank you so much for your responses! The podiatrist we are billing for just joined the group and I have not had to bill for one before. I don't mind having to appeal a denial as long as I know for sure I have billed it correctly in the first place. With your responses I feel more comfortable billing this out.
Thanks again!
Cathy
 
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