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Wiki Multiple Providers seen on the Same Day

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Jody Mortensen

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I'm reading the Medicare claims manual & it states "physicians in the same group practice but who are different specialties may bill & be paid without regard to their membership in the same group". I'm being asked if a modifier is needed from the biller for a patient that saw a cardiologist & their family practitioner on the same day. I wanted to ask what other's do with the same scenario. I don't see that there should be a problem with the 2 providers billing on the same time since they are in different specialties, is my assumption correct?

Thank you
Jody Hecht
 
We have had a problem getting them paid on the first claim, but we have had success appealing the claims. There is no modifier to use.
 
You shouldn't have a problem getting paid if the two providers were set up with different CMS specialty codes.

The cardiologist should be set up with specialty code 06 and I believe internal medicine is 11.

Lisi, CPC
 
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