Urology Coding Alert

Question: If for a valid reason two of my doctors see the same patient on the same day in the hospital for follow-up, can I bill for both services? The first urologist saw the patient during the night around 2 a.m. due to urinary complications. That urologist was the one on call at that time. Urologist 2 saw the patient in the afternoon the same day during rounds for normal hospital follow-up. Can I bill two inpatient codes?

Louisiana Subscriber

Answer: Payers following Medicare rules expect you to code for physicians in the same specialty and same group as if they’re a single physician. Below are some quotes that may help from Medicare Claims Processing Manual, Chapter 12 (http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf):

·         30.6.9.B: Two hospital visits same day: “Contractors pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not. The inpatient hospital visit descriptors contain the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician should select a code that reflects all services provided during the date of the service.

·         30.6.9.C: Hospital visits same day but by different physicians: “In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering for A, sees the same patient in the evening, contractors do not pay physician B for the second visit. The hospital visit descriptors include the phrase “per day” meaning care for the day. If the physicians are each responsible for a different aspect of the patient’s care, pay both visits if the physicians are in different specialties and the visits are billed with different diagnoses. There are circumstances where concurrent care may be billed by physicians of the same specialty.”

·         30.6.5: General E/M instruction about physicians in group practice: “Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level. Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group.”

Bottom line: Assuming both urologists are in the same specialty, you should combine the work of both services and report just one inpatient code.