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Coding in group practice

Paras Posted Tue 16th of October, 2012 03:34:29 AM

1) if a general ophthalmologist diagnoses a retinal tear, refers to a retinal specialist in the same group on the same day, can both MDs bill for an exam?

2) in the scenario above, if the visits are for different problems, can both MDs bill for an exam?

SuperCoder Answered Wed 17th of October, 2012 21:32:38 PM

Each physician could bill for his or her critical care time ,as long as the times billed do not overlap.

All of these scenarios come with the same caveat: Any time multiple physicians are caring for the same patient, they must establish and document the medical necessity of each of their services.

What this often means is that two physicians billing for the same patient on the same date of service will likely need different diagnoses to avoid a denial, regardless of whether or not those doctors belong to different specialties and/or groups.

Remember too that you'll have to rely on documentation to appeal a claim if it's denied. Make sure your documentation clearly reflects the diagnoses you addressed and the full picture of the patient's illness, as well as the medical need for your services.

Your case

1) No, only one can bill.

2) Yes, since the medical necessities are different now.

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