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postop visit

Caralee Posted Wed 28th of August, 2013 11:21:12 AM

Our group practice is a multi speciality. Pt. had major neurosurgery done by neurosurgeon.. Pt. was seen by other specialty dr (physical medicine and Rehab) from the same group in the hospital for f/u visit 3 days later. we bill under same group TaxiD# for both drs. My question is can we bill for Physical meds and rehab dr's hospital f/u visit or it is still consider post op and not billable? Thank you.

SuperCoder Answered Thu 29th of August, 2013 11:07:38 AM

Because the MDs have different specialties, you should be able to report the second MD's visit. But the mention of follow-up raises the question of whether there was transfer of care and division of pre-, op, and post- services and charges.

Assuming there was no transfer of care, these resources may help in your decision:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/GloballSurgery-ICN907166.pdf

Medicare payment for the surgical procedure includes the pre-operative, intra-operative and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.

Page 12, https://www.medicarenhic.com/providers/pubs/REF-EDO-0056%20EvaluationManagementServicesBillingGuide.pdf

Physicians in a Group Practice

Same Specialty
Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.

Different Specialty
Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group.

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