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Is this "ok"?

  1. #1
    Greeley, Colorado
    Question Is this "ok"?
    Medical Coding Books
    Group OB practice of 5 docs. Each has their own patients that they follow thru pregnancy. If Dr. A is the patient's primary OB doc, and Dr. B admits the patient for pyelonephritis during pregnancy, Dr. A still does the billing even though he did not do the admit, f/u visit or documenation for either...he only saw the pt for discharge. It is my opinion that this is not appropriate coding/billing. If these dates were audited, how could they possibly support Dr. A billing when he didn't do any of it? Is this common practice for OB? Anyone else have an opinion?
    Lisa Bledsoe, CPC, CPMA

  2. #2
    Greeley, Colorado
    Exclamation Please help!
    I really could use some opinions/guidance on this question!
    Lisa Bledsoe, CPC, CPMA

  3. #3
    I think this still falls under the reciprocal billing and those services would be identified with a Q5. I know under the other post your concern was obviously most of these patients will not be Medicare. I found this article from The Coding Institute.

    "Private payers have no equivalent reciprocal billing modifier, but you
    might still want to use Q5. If you are audited and the auditor questions
    your billing of patients your physician did not see, you can explain that
    you indicated this with modifier Q5 as Medicare requires and accepts."

    I found another publication from an insurance carrier from back in 2004 stating they don't recognize this modifier because they don't allow reciprocal arrangements and require all services be billed under the actual provider of service. The carrier was IHC, never heard of them myself.

    So it sounds like this will be a carrier by carrier determination.

    Laura, CPC, CPMA, CEMC

  4. #4
    Greeley, Colorado
    Thanks for the help Laura. I feel like I'm sinking.
    Lisa Bledsoe, CPC, CPMA

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