Wiki Multiple providers billing observation codes

[Slhernandez]

Hello! I'm reviewing some claims right now in which we have multiple providers from the same group billing for observation services. It's been my understanding, with Medicare, that only the treating physician can bill for observation codes while the other doctors can bill using other professional consult/E/M codes. If someone can please help me. Thank you!

 

[jkyles]

Hi there, are they the same specialty?

 

[Slhernandez]

There are 2 internal meds and 1 PA; I'm going to say the PA is internal medicine as well

 

[jkyles]

For the purposes of reporting their services they're all one person. CMS 100-04, chapter 12, ss30.6.5 https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf

30.6.5 - Physicians in Group Practice
(Rev. 1, 10-01-03)
Physicians in the same group practice who are in the same specialty must bill and be paid as
though they were a single physician. If more than one evaluation and management (face-to-
face) service is provided on the same day to the same patient by the same physician or more
than one physician in the same specialty in the same group, only one evaluation and
management service may be reported unless the evaluation and management services are for
unrelated problems. Instead of billing separately, the physicians should select a level of service
representative of the combined visits and submit the appropriate code for that level.
Physicians in the same group practice but who are in different specialties may bill and be paid
without regard to their membership in the same group.