# Billing for Primary Care and specialist (Article 28 facilty) same day appt's



## cwestman (Sep 24, 2017)

Hoping that someone can help ,I recently(2 weeks now) started a new job as a CPC-A. There are many things I need to learn about article 28 facility and I guess how it affects how we bill for certain services. I can't help but feel that as an article 28 facility same day appt's would/should be an essential key to the community as well as being able to bill for same as a service provided
Our Providers all work under the same tax ID this includes several Primary Care MD's, PA's and NP's in addition to a Surgeon and Cardiologist All very beneficial services to a rural community as some patients  will travel up to an hour for appt's /procedures.This can be a hardship ,especially for our elderly that often brought to appt's by their children (who have to miss a day of work in order to help their parents) 
I have been told that because we are an article 28 facility and as the Providers work under the same tax ID we just can't schedule any same day appt's for specialist and Primary care As well that when a patient is a new patient for the Cardiologist ,Surgeon or PCP we can never use the 99201 -99205 codes Both reasons would cause the claim to be rejected and that only 1 of claims  would be paid Even with use of modifier 59 
I didn't ask administration if they were using the newer more descriptive modifier  XP as I felt I need to research the use before bringing  that subject up, unfortunately I can't find that needed information
I would love to be able to accommodate our patients better and as well be able to have the Providers reimbursed appropriately  If anyone can advise me or direct me to the proper source for the information I would greatly appreciate your help I would have checked the NCCI edits but I believe that comes as a cost which I just can't afford right now As well I don't now that that would be specific for the article 28 facility ?? Wondering if well if there is a payer specific caveat
Thank you In advance for any advice, direction in this  matter.
Cheri CPC-A


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## Davieda Skobel (Sep 26, 2017)

*Billing for Primary Care and specialist on the same day.*

Unfortunately, with all the physicians billing under the same tax ID there isn't much you can do to save the patients time and effort or collect the money the physicians are due.The Tax ID is the main identifier that medicare uses.

As I am sure you know all the rules of billing are in the back(I have an Optum 360 Current procedural Coding Expert book) of the book. Medicare doesn't pay for Consults so you can't even do an office visit with the primary and a consult with the specialist and with the same Tax ID you have two strikes against you.

It appears you are in quite a pickle!
If the Physicians want to get paid the patients will have to visit on two different days.
If your specialists had their own Tax ID you could bill and provide care much more efficiently.I am not sure that is even possible for you.
Oh and the XP would be correct here.

Just my thoughts and by no means absolutely right.
Hope it helps some.
Davieda


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## cwestman (Sep 27, 2017)

Thank you Davidea,it wasn't the answer I had hoped for but dose help me understand 
Thanks again for your time 
Cheri CPC-A


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