Julia Posted Wed 01st of October, 2014 16:18:10 PM
When a report is signed out by physician A and an addendum, for special testing such as an IHC stain for example, is signed out by physician B, do you need to bill the special test on a separate claim with physician B as the rendering? For example, we have breast cases that are reviewed and reported by physician (A) and a breast panel will be ordered by physician (A) but another doctor (B) will dictate the results of that test in the original report as an addendum. Physician B also signs a separate report for the special testing.
Another scenerio is with bone marrow cases. Physican (A) will interpret the slides and dicate a report for his findings, order flow cytometry and another physican (B) will interpret the results and another report will be generated for the flow but an addendum is added to physican (A)'s report.
Do we bill with physican (A) the rendering doctor who orders the tests, or physican (B), the doctor who signs out the report for said special test and dictates addendum?
We are a group and bill with group tax ID so I'm not sure if that changes things?
Julia Posted Mon 06th of October, 2014 15:07:56 PM
SuperCoder Answered Mon 06th of October, 2014 16:35:56 PM
Thank you for your question.
You would want to bill Physician A. Physician A is ordering the tests as well as doing an interpretation. Physician B is adding an addendum and an additional report. Physician A is completing the tests, while Physician B is adding to the service, and while his services are appropriate for protocol and/or office procedure/clinical necessity, Physician A would be the correct provider to bill for.
Julia Posted Wed 08th of October, 2014 12:06:25 PM
Physican B is actually interpreting the special test not just dictating the addendum. Does this change we'd bill?
SuperCoder Answered Thu 09th of October, 2014 07:56:30 AM
No. The code cannot be billed twice by the same practice with the same tax id on the same day in this case. You would only be able to bill for one providers service.
Julia Posted Thu 09th of October, 2014 11:50:02 AM
I'm not asking if we can bill for both providers. I'm asking if we need to separate the codes by the physican interpreting and signing the report.
Example: breast bx with ER, PR, HER2 and Ki67 (computer assisted)
Physican A reads slides from bx and orders ER, PR, HER2 and Ki67
Physican B reads interprets the ER, PR, HER2 and Ki67 creates report separate from pathology report, signs said report and puts addendum in physican's A pathology report.
Do we bill:
Physican A- 88305, 88361 x4
Physican A- 88305
Physican B- 88361 x4
SuperCoder Answered Fri 10th of October, 2014 06:46:35 AM
Thank you, the original question was then unclear of that:
"Do we bill with physican (A) the rendering doctor who orders the tests, or physican (B), the doctor who signs out the report for said special test and dictates addendum?"
You may separate out the codes, however, if a group with the same tax id, same specialty bills for the same service on the same day, one will not pay.
Julia Posted Fri 10th of October, 2014 11:13:40 AM
Again, we are not trying to bill the same same services for both pathologists. We are asking which way is correct. I will pose this question on another forum, as this one does seem to understand the question being asked. Thank you.
SuperCoder Answered Fri 10th of October, 2014 15:56:46 PM
We apologize that we are not understanding your question.
Earlier in the thread we posted:
You would want to bill Physician A. Physician A is ordering the tests as well as doing an interpretation. Physician B is adding an addendum and an additional report. Physician A is completing the tests, while Physician B is adding to the service, and while his services are appropriate for protocol and/or office procedure/clinical necessity, Physician A would be the correct provider to bill for. - See more at: https://www.supercoder.com/my-ask-an-expert/topic/addendum-reporting#sthash.41OBDllM.dpuf
Thank you for your submission and we hope to further assist you in the future.
Julia Posted Tue 14th of October, 2014 11:25:21 AM
Also earlier in the thread I clarified that although physician A orders the additional testing, physican B is doing the interpretation. I understand physican B is adding to physician A's service but if he is doing the interpretation and a separate report is generated, wouldn't we want to bill with him as the rendering provider?
SuperCoder Answered Tue 14th of October, 2014 17:58:30 PM
You would want to bill for the provider that does a majority of the service.