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Thread: change of provider

  1. #1

    Default change of provider

    AAPC: Back to School
    Patient is seen by Dr. Johnson & the decision is made for surgery. The provider is changed to Dr. Smith. Since Dr. Smith has never seen this patient, he does his own examination and will be the one to perform surgery. Can Dr. Smith bill for an E/M code?

  2. #2
    Join Date
    Apr 2007
    Milwaukee WI

    Default Not if same practice, same specialty

    If both doctors of the same practice, same specialty they are considered one person. No charge for the E/M by Dr Smith.

    If they are of two different practices or two different (recognized) specialties, then Dr Smith may perform his own evaluation and charge for it (with -57 modifier if it's the decision for surgery within the global period).

    So, for example, Dr Ortho sees patient and determines need for surgery, but due to schedule conflicts turns the case over to his partner in the practice, Dr Paedic. No charge for E/M by Dr Paedic, as they are considered the same doctor.

    On the other hand, Dr Ortho sees patient and determines need for surgery, but patient decides to instead go to Dr Different Practice for the procedure. Dr D Practice may charge for an E/M. (-OR- goes to Dr Different Specialty ... e.g. patient w/ ganglion of wrist sees Ortho first but decides to go to the Hand Surgeon instead.)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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