Wiki Inpatient Coding 2 physicians same day

[MT]

If an int med MD is asked by their partner who is a family practice MD to see one of her patients in the ICU for his opinion can he bill a consult? These 2 physicians work in the same rural health office, same tax ID, etc...Both see the patient in the ICU on the same day.

 

[FTessaBartels]

Two key questions

Question 1 .... is the patient covered by Medicare, or any other payer who does not recognize consult codes?

Question 2 ... are the two physicians of different specialties?

Q1 Yes, Q2 Yes .... physician # 2 will bill the appropriate inpatient E/M code

Q1 No, Q2 Yes ... physician #2 may use the consultation codes (if that is what is documented)

Q1 Yes, Q2 No ... physician # 2 may not bill; same specialty & same practice is considered same physician. You should consider all the documentation together to arrive at the appropriate level of service to bill, under ONE physician.

Q1 No, Q2 No ... Same answer as immediately above.

Hope that helps.

F Tessa Bartels, CPC, CEMC