Wiki Board certification for Hand specialty

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PKOHUT

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Local Chapter Officer
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Does A Hand specialist have to be board certified in order to bill new patient E/M that is referred by another in the same group?
 
I have a few questions about your question.
  • Do both providers have the same taxonomy code, or are they different? If the providers have the same taxonomy code, most payers are going to consider the hand specialist as the same specialty as the referring provider in the same group. If they are different then you "should" be able to bill a new patient.
  • Is the hand specialist credentialed with your various payers as a hand specialist, if not what specialty are they credentialed as? If your hand specialist is not credentialed with this specific sub-specialty, it is more likely than not that their system will edit the new patient visit claim with the hand specialist and down code it to an established patient visit, or deny the visit as being billed incorrectly.
  • If the hand specialist isn't credentialed with the correct taxonomy code with your payers, you need to submit requests to update the providers credentialing to reflect the correct taxonomy code. There are 2 taxonomy codes for the sub-specialty of hand surgery:
    • 207XS0106X - An orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist. This taxonomy code is for orthopedists who have a sub-specialty of hand surgery.
    • 2086S0105X - A surgeon with expertise in the investigation, preservation and restoration by medical, surgical and rehabilitative means, of all structures of the upper extremity directly affecting the form and function of the hand and wrist. This taxonomy code is for surgeons who have a sub-specialty of hand surgery.
I don't know if you have ever looked at the NUCC website which lists all taxonomy codes but if you haven't here is the link to their taxonomy overview page Health Care Provider Taxonomy. Here is a screen snip of how to navigate to the taxonomy code look up tool.

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I hope this information helps you figure out the answer to your question.
 
CBLENNIE said:
There are 2 taxonomy codesfor the sub-specialty of hand surgery:
  • 207XS0106X - An orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist. This taxonomy code is for orthopedists who have a sub-specialty of hand surgery.
  • 2086S0105X - A surgeon with expertise in the investigation, preservation and restoration by medical, surgical and rehabilitative means, of all structures of the upper extremity directly affecting the form and function of the hand and wrist. This taxonomy code is for surgeons who have a sub-specialty of hand surgery.
Click to expand...
Three taxonomy codes.

207XS0106X - Orthopaedic Surgery - Hand Surgery
2082S0105X - Plastic Surgery - Surgery of the Hand
2086S0105X - Surgery - Surgery of the Hand

So, a “hand surgeon” can be an orthopaedic surgeon, a plastic surgeon, or a general surgeon, each having completed fellowship training in hand surgery.

Fellowship-trained hand surgeons may have residency training in either orthopedic, plastic, or general surgery, generating significant variability in education background.
Click to expand...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9381175/
 
Great advice above. I would add, even if the credentialing/taxonomy meets the different requirement, the payer may not care. They may only look at the TIN of the group or group NPI. So, they would still see it as an established patient. In addition to checking the above, you would also have to know your payer guidelines for new vs. established within the same group.
 
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