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Same Tax ID but different speciality

  1. #1
    Question Same Tax ID but different speciality
    Medical Coding Books
    Issue we are having is we have providers in different specialities, Radiation Oncology, Surgical Oncology, and Medical Oncology but all under the same tax id number. Our providers will refer patients to each of the specialities and therefore the provider in the "new" speciality will charge a new patient E/M, since he/she is new to them. Is this correct?

    Example: pt see's Medical Oncology on 3/25/10 level of E/M 99204 then is referred to Radiation Oncology for a visit on 3/29/10, the Rad Onc will then charge a 99204 is this correct?

  2. #2
    Because they are all oncologist you may have an issue. Are they set up under different taxonomy codes?
    Susie Corrado, CPC
    ENT Coding/Billing

  3. #3
    Adirondack Chapter of Professional Coders, Glens Falls, NY
    I work for a large group comprised of over 12 health centers and all of our providers bill under the same tax ID. As long as the doctor that the patient is referred to is seeing the patient for the first time or hasn't seen the patient in over 3 years, they are considered a new patient to that provider. However, because we all bill under the same tax ID, we can bill either way. It is pretty much at the desceretion of the provider if they want to bill for a new or established patient, beause they are established within our network of providers, but not necessarily with the provider they are referred to. I guess my answer is, yes, you can bill for new patient services under the same tax ID. I hope this helps!

  4. Default
    Honestly, what it all boils down to is how they setup with credentaling dept. If the paper is submitted with only their name and they aren't listed with their speciality you may problems, yes you can bill under one tax id as long as they were setup with their speciality listed.

  5. Default
    I would agree you would need to understand credentialing and possibly contracts. However, the patients are being referred to subspecialists within their specialty. So, a new patient visit is billable. There may be a denial but you can appeal with notes indicating need for subspecialist.

  6. Default
    So.. in the case that you have more than one of the same type of specialist (i.e. neurologist) within your practice but one specializes in seizures and the other in sleep disorders, would it be ok for both to bill new for the same patient even though the high level speciality is neurology?

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