Wiki second time looking for opinions

[Lisa Bledsoe]

Scenario: Patient of practice A is delivered by a physician of practice B. These practices have an agreement that regardless of who does the deliviery, the practice that provided the antepartum care will charge for the delivery - even though they didn't do it. So the practice B doctor is the delivering doc, but practice A doc bills global 59400. Is this appropriate?

 

[LLovett]

If they have an agreement my understanding is yes, it is appropriate. This falls under reciprocal billing, Q5 modifier.

http://www.cms.hhs.gov/Transmittals/Downloads/R1486CP.pdf

I don't have any providers in that type of arrangement and I never have but there are several who have responded previously to other similar posts stating they do, hopefully they will answer with more info.

From a risk stand point I don't personally understand why you would enter into this kind of arrangement but that is just me.

Laura, CPC, CPMA, CEMC

 

[Lisa Bledsoe]

Thanks for the link Laura. It just seems funny to me that the documentaion will be by another provider, yet we are going to bill for it. Since these are non-Medicare patients, I'll have to look into the Q5 modifier with other payors.