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Appointment types within multi physician practice

  1. #1
    Default Appointment types within multi physician practice
    Medical Coding Books
    The CPT manual clearly states that a patient who is seen within 3 years by a physician or other physician within the same group is not a new patient. If the one physician from the practice refers the patient to another physician in the practice on the same day, should we then use an established office visit? what if they see the patient on another day? Which modifier, if any should be used to receive payment?
    Thank you in advance for any help given !

  2. #2
    Location
    Dover Seacoast New Hampshire
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    2,028
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    The CPT manual also gives you a flow chart to determine when that 3 year rule would not apply, as in different specialty or sub specialty. Because they're in the same "practice" or "office" doesn't mean you might not bill a new patient. We have a multispecialty practice that consists of over 55 providers in several sites, but they're of different specialties so that allows us to bill new patient visits when the patient is seen by a provider of a different specialty than they previously saw. For example, we have a cardiovascular practice, with both cardiologists and vascular surgeons. The patient could see the cardiologist, and then be referred to the vascular surgeon. New patients both.

    If one provider of the same specialty refers to another provider of the same specialty and they see the same patient on the same day (why?) then you'd be required to bundle the documentation into a single code and bill only once. This happens a lot in the inpatient setting, when more than one hosptialist sees the same patient on the same day. Hope this helps.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  3. #3
    Location
    Sioux Falls, SD
    Posts
    56
    Default appt in multi physician practice
    do all theses physicians have the same tax id number?? we have been told we could not bill a visit with our podiatrist and a visit with an ortho doc the same day because they have the same tax id.
    Donna Struve CPC
    NW Iowa Bone Joint Sports Surgeons

  4. #4
    Location
    Baton Rouge
    Posts
    1,241
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    Quote Originally Posted by dstruve View Post
    do all theses physicians have the same tax id number?? we have been told we could not bill a visit with our podiatrist and a visit with an ortho doc the same day because they have the same tax id.
    I don't agree with this. Tax ID has more to do with how the payment comes. NPI is more important when figuring new vs established, due to the taxonomy code each provider is registered under when their NPI is set up. If 2 providers are under different taxonomy codes (ie. different specialty/subspecialty), they both have the right to bill New Patient codes.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  5. #5
    Location
    Sioux Falls, SD
    Posts
    56
    Default appt types within multi physician practice
    So our NPI numbers are set up with different taxonomy codes for the different specialists. I understand the new patient thing but what about two docs of different specialties seeing the same patient on the same day?? Usually we only allow one physician to bill and the other is out. But if the podiatrist is evaluating a foot ulcer, trimming nails and the ortho doc is seeing them for osteoarthritis knee, Can we bill them both?
    Donna Struve CPC
    NW Iowa Bone Joint Sports Surgeons

  6. #6
    Location
    Baton Rouge
    Posts
    1,241
    Default
    Quote Originally Posted by dstruve View Post
    So our NPI numbers are set up with different taxonomy codes for the different specialists. I understand the new patient thing but what about two docs of different specialties seeing the same patient on the same day?? Usually we only allow one physician to bill and the other is out. But if the podiatrist is evaluating a foot ulcer, trimming nails and the ortho doc is seeing them for osteoarthritis knee, Can we bill them both?

    If the 2 providers are different specialties, you should be getting paid for both of them on the same DOS.

    You can view their taxonomy codes here, just enter their NPI numbers:

    https://nppes.cms.hhs.gov/NPPESRegis...searchType=ind
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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