Primary Care Coding Alert

Question: Can a patient be seen by two different providers in a billing group on the same day if the providers are from two different specialties?

West Virginia Subscriber

Answer: If the physicians have different taxonomy numbers, proving the different specialties, you should be able to bill the two different doctors/two different specialties and get paid for both services. The payer may deny one of them, and if so, you will need to appeal and show the different specialties, separate services, and the different taxonomy numbers.

Payers often consider working together as partners in the same practice and same specialty as one billing person. Even though the physicians have different NPI numbers, both bill under the practice’s tax ID number. Some payers to which you bill services on the same day but at different times will reimburse based on the date of service not on the time of day the service was performed on the same day. That means that the payer would consider the same-day services bundled (whether two E/Ms or an E/M and a procedure). You would normally combine both E/M services into one E/M code, but having different specialties makes a difference.

Since the physicians have different specialties, you can report both services, assigning the appropriate (and presumably different) diagnosis codes. Then, if necessary, appeal the denial with documentation for both providers’ services, showing that two different specialties performed the services for different medical conditions, and explain the difference in the physicians’ expertise.