Wiki Multispecialty Group Billing

[taylorbalford]

I work for a multispecialty group and I am new to coding. I am trying to research the following..

Can a patient be treated by both the MD, DC, and/or PT on the same day? If so, what can be billed under each? Any applicable modifers?

Also, if you can provide any references that would be very appreciated. Most of what I find refers to same day service with the same specialty.

 

[TiffianyEdwards]

Md dc pt

Are they all under the same tax id?

You shouldn't have a problem unless you come across them using the same codes, which with pt you wouldn't have the same codes with an MD.

You are basically going to have to trial and error it and learn from your denials that is how I learned. I wasn't able to find many resources, I am currently billing pulm, neuro, pain mgmt, nephrology, rheurmatology, infectious diseases, and the sleep lab.

If you need any help feel free to email me at Tiffiany.Edwards@crmcwy.org

 

[shellysk8]

Same or Different Provider

The main question is whether or not the providers seen meet the definition of "Different Provider". There is a decision tree that can be helpful in your CPT book in the area discussing new vs. established patients. Basically, if the providers in question are billing under the same Tax ID, and have the same specialty/subspecialty, you likely shouldn't be billing separate visits for them for the same patient same date of service. However, if the providers bill under the same Tax ID and have different specialties, then they are considered different providers, and you can bill separate visits for them, even for the same patient on the same date of service. If they utilize different Tax IDs, then you have no issue at all. Some payers recognize subspecialties (like retinal ophthalmology vs. ocularplastic surgery vs. ophthalmology) while other payers consider all of these ophthalmology and will not pay separately for visits to each subspecialty. You would need to check payer policies on this. Likely it would be listed under new vs. established payment policy.

I hope this helps!
Shelly L. Kubacki, MPA, CPC