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Thread: Please help me!!!!!

  1. #1

    Angry Please help me!!!!!

    AAPC: Back to School
    Practice with multiple MD's, internists, cardiologists, orthos, gyns, and gastroenterologists. All of these physicians practice in different cities in different office under one tax id.

    If an interernist (Primary care doctor) refers the patient to one of these providers on the same day of service are both of these services going to be payable? If so, under the new consult guidelines with Medicare, how would this be billable? Would this not also be considered as concurrent care for the patient for the same day under the same TIN by the payer?

    Any information would be most appreciative. Thanks in advance for your help!!!!!


  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    There should not be a problem as long as the second provider is a different specialty. If the payer is Medicare or one that follows Medicare rules for consults then it will be an ov code.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Kansas City, MO


    Medicare will first look at the Tax ID, but then the specialty the doctor is signed up as with them. If they are a different specialty they can both bill their services. Per Medicare...same tax id and same specialty equals same doctor in their eyes.

    We have several primary care clinics in different cities, and patients were changing clinic sites, and the providers were wanting to charge them as a new patient. Because they are all the same specialty, and bill under the same tax ID, they should be established patients.

  4. #4
    Join Date
    Apr 2007
    Greeley, Colorado


    I agree with Debra and Linda.

    On a side note, looking at your user name, you don't by chance watch The United States of Tara on Showtime do you?? I love that show!
    Lisa Bledsoe, CPC, CPMA

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