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Billing Under A Group Practice ??

  1. #1
    Default Billing Under A Group Practice ??
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    Can someone please offer some advise as to how to properly bill these types of situations?

    Our office has gone from billing the doctors charges under their own separate Tax ID # to billing under one group Tax ID #.

    1.) Dr A performs a surgery with a 90 day global period. The patient is discharged, then pt represents for same problem and is treated by Dr. B. We know we cannot bill for another E/M but will we now be appending a -78 to Dr. B's surgery since he is under the same tax ID?

    2.) Dr A performs sx w/ 90 day global period and discharges, then pt represents w/ completely different problem and is teated by Dr. B, would we now append mod -79 to the first Dr. B surgery?

    ***Please note that prior to 09/01/09 we were billing under separate Tax ID # and as of 09/01/09 we are billing under the Group Tax ID#.****

    3.) Another scenario has come up where Dr. C treated the pt before 9/1/09 and now pt has come back w/ same problem but Dr. F is now treating after 9/1, can we bill for Dr. F consult or not, and if not do we need a -58 on his surgery? I am pretty sure that we cannot bill for the consult as it is the same specialty.

    Thank you in advance.

  2. #2
    Milwaukee WI
    Default You have # 1 and # 2 correct
    You are absolutely correct on scenario # 1 and # 2 ... Once they are in the same practice they are considered "the same physician."

    For scenario # 3 you would code an E/M only if you were outside the original global period. It would not be a consult if it's the same problem, but rather an established patient visit with decision for surgery. You would use mod -58 or -78 depending on whether the second surgery was previously planned/anticipated or whether it was unplanned return.

    Think of this as if the practice had brought in a new physician. Any of the doctors previous patients would still be considered established to him/her AND to anyone else in the practice because the patient had received face-to-face service by the physician or another physician in the same practice of the same specialty within the last 3 years.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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