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2 E&M visits same DOS - cardiologist & electrophisiology

Erin Posted Fri 08th of November, 2013 17:34:43 PM

Help please, commercial carrier bundling the electrophisiology doctor's visit with the cardiologist visit - seen for distinct reasons. Thanks

SuperCoder Answered Sat 09th of November, 2013 16:30:56 PM

We are working on this.

Thanks

SuperCoder Answered Sat 09th of November, 2013 16:30:56 PM
With Deb
SuperCoder Answered Mon 11th of November, 2013 17:02:54 PM

Does the payer provide any guidance? While CMS has distinct specialty codes for cardiac EP and cardiology, the private payer may not have adopted that approach. It’s possible the payer recognizes concurrent care and would allow billing both separately if you appeal with proof that the visits meet the payer’s standards, and you do mention that these were for distinct reasons. This may be an issue for contract discussion, as well.

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