Internal Medicine Coding Alert

Question: Some people have told me that if a patient is in a skilled bed and is being considered as a Part A stay, the physician bills the nursing home for his visits. Others have told me that physician visits are always billed to the insurance as Part B and that they are excluded from consolidated billing. Who is correct?

Kentucky Subscriber

Answer: The latter information is correct. The physician bills his professional fee (the CPT code that reflects the physician's work) to Medicare Part B. The facility, i.e., the nursing home, bills its services to Medicare Part A. Consolidated billing rules cover only the facility billing, not the physician (professional fee) billing.

Therefore, you don't need to concern yourself with consolidated billing rules if you are coding for a physician.