Primary Care Coding Alert

Question: I have several questions regarding a situation where one doctor visits another physicians office and provides services to the patients there:

1) What place of service code would we use on the HCFA-1500 claim form?
2) What Medicare number do we use for billing?
3) Would it be the doctors identification number for the state that he has been assigned? .

New York Subscriber

Answer: Reporting the correct place of service will depend on the financial arrangements your physician has made with the other practice. Generally, place of service 11, office, is reported. The visiting physician and the practice may agree mutually to share a portion of the reim-bursement received. Or the visiting physician may be charged a flat fee per patient to reimburse the practice for supplies and/or practice personnel used. Under certain arrangements, place of service 22, outpatient hospital, may be used. If the practice bills a facility fee, the visiting physician would bill for his or her professional services only.

Report the visiting physicians provider number for services provided in the physicians practicing state. If the visiting physician is practicing in another state or in a state with multiple carrier jurisdictions (e.g., New York), he or she must obtain a provider number for that specific carrier.

Sometimes, in long-standing relationships, the practice will obtain a provider number for the visiting physician as if he or she were part of the group. In this instance, the practice would bill and collect all reimbursement. The visiting physician is then paid a salary or per diem rate by the practice.