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E/M for Nephrology/Dialysis Need Help

  1. Default E/M for Nephrology/Dialysis Need Help
    Medical Coding Books
    We have 2 dialysis patients that are "locked in" to a certain provider in our practice due to their insurance (VA and GA Mcaid). My question is what if another dr in the practice provides the comprehensive exam for the dialysis patient and it isnt who they are locked in to? The manager is wanting me to bill it under who they are locked in to, but I feel like I would be lying.Thanks

  2. #2
    Why did they see a different provider? Was theirs gone and this one covering? If so look into reciprocal billing. You would bill under their allowed provider with a Q5 modifier.

    Or was it a locum tenens? That would still be under their approved provider but with a Q6 modifier.

    Laura, CPC, CPMA, CEMC

  3. Default
    No we have 3 doctors in this practice and these particular insurances only allow the 1 to be on the referral.

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