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Different fees for mutispecialty group?

  1. #1
    Question Different fees for mutispecialty group?
    Medical Coding Books
    Can we bill same code a different fee depending on specialty in a large group with same tax ID number? Can a family doctor bill one fee for 99213, an orthpedic bill another fee for 99213, and a neurologist in the same group (TIN)
    bill a different fee?
    We work for a large orthopedic practice with difference specialties.
    Thank you so much in advance.
    Lynn Spille, CPC

  2. #2
    Hi Lynn,
    Are you asking what you would be paid or what you are allowed to bill?
    It all comes down to your physicians contracts with the payers. Are they all contracted at the same rate for each specific payer? I'm not a whiz with mediare/medicaid rules, so I cant speak to that, but for private payers, they typically contract the large groups all in one. An E/M 99213 from an Osteo should be the same level of work as an E/M 99213 from an Internal Med, the documentation requirements are the same regardless of the specialty, so reimbursement would not differ. But your safest bet would be to request contract rate info from each payer you do business with.
    I know thats not much help, but thats my best suggestion.

  3. #3
    Thanks so much. That is what we thought too.

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