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Lori Posted 1 month(s) ago
We bill for a hospitalist group and need coding/billing guidance. If Provider A sees a patient for a subsequent visit in the morning. Then Provider B sees the same patient for an additional subsequent visit later that night. What is this appropriate way to bill these two services since they will hit up against one another, and only one service/claim paid? I have been told it is acceptable to select one code that represents the "average" level of service rendered by each provider and bill accordingly. For example, Provider A's visit was a level 2, and Provider B's visit was a level 4. Therefore, you would submit a level 3 (the average of both visits combined) for one of the providers only. Is this an accurate statement? If so, please provide confirmation from CMS, Medicare, or whomever that this is a ligament way to bill for subsequent visits for all of the hospitalist in this group.
SuperCoder Posted 1 month(s) ago

Greetings from SuperCoder!

 

As per CMS, “In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering for A, sees the same patient in the evening, contractors do not pay physician B for the second visit. The hospital visit descriptors include the phrase “per day” meaning care for the day.

 

If the physicians are each responsible for a different aspect of the patient’s care, pay both visits if the physicians are in different specialties and the visits are billed with different diagnoses. There are circumstances where concurrent care may be billed by physicians of the same specialty.”

 

For more information, please visit link: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R2282CP.pdf

 

Please feel free to write if you have any question.

 

Thanks.

Lori Posted 1 month(s) ago
Based on that response, I have one more question. What about two physicians from the same Hospitalist Group with this scenario. Provider A sees a patient in the morning for the initial visit, and provider B sees the same patient later that day for a subsequent visit. Do both providers get paid? Or will the payer only pay one claim for that specialty in the same grp/NPI per day?
SuperCoder Posted 1 month(s) ago

Hi,

 

Same guideline applies to this scenario too because code descriptors of both codes (initial and subsequent) says "per day" and you cannot report both codes on the same day.

 

Both visits can be paid if the physicians are in different specialties and the visits are billed with different diagnoses.

 

Hope it helps.

 

Thanks.

Posted by Lori, 1 month(s). There are 4 posts. The latest reply is from SuperCoder.

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