NBarna
Guest
Lots of questions posted about Prolonged Services, but I couldn't find one addressing this specific question:
Facts:
. Hospitalist group
. One hospitalist admits patient & bills 99223
. Second hospitalist sees patient later & bills prolonged service (99356)
Assume all of the time and documentation criteria are met to bill these codes. Question: Is it appropriate to bill 99223 for one hospitalist and 99356 for another hospitalist? Medicare has rules in its Physician Claims Processing Manual at 30.6.5 stating that physicians in a group practice should bill as a single physician; however, the language in the Prolonged Services section (30.6.15) consistently refers to the "same physician" providing both the base E/M service and the prolonged service. Since 99356 is an add-on code, billing it on a separate claim under the second hospitalist will surely hit a claims-processing edit. I am to the point of convincing myself that the prolonged service codes must be billed by the same physician who billed the base code. Is this consistent with the thought / knowledge of others?
Thanks for any help anyone can provide.
Facts:
. Hospitalist group
. One hospitalist admits patient & bills 99223
. Second hospitalist sees patient later & bills prolonged service (99356)
Assume all of the time and documentation criteria are met to bill these codes. Question: Is it appropriate to bill 99223 for one hospitalist and 99356 for another hospitalist? Medicare has rules in its Physician Claims Processing Manual at 30.6.5 stating that physicians in a group practice should bill as a single physician; however, the language in the Prolonged Services section (30.6.15) consistently refers to the "same physician" providing both the base E/M service and the prolonged service. Since 99356 is an add-on code, billing it on a separate claim under the second hospitalist will surely hit a claims-processing edit. I am to the point of convincing myself that the prolonged service codes must be billed by the same physician who billed the base code. Is this consistent with the thought / knowledge of others?
Thanks for any help anyone can provide.