Wiki 2 providers, 2 visits, same practice

[cmmfeyen]

Pt is seen by DR. A for glaucoma follow up.
Dr. A refers pt to Dr. B for macular degen – same day.
Both Dr.'s work in the same practice - can we bill for both??

I don't believe we can unless one of the providers is a MD and the other is an OD. I can't find documentation on this, can anyone help answer this?

 

[thomas7331]

The guidelines of CMS and most other payers state that two providers in the same practice and of the same specialty are treated as the same provider for billing and coding purposes. So as I understand it, you could bill for both if the two providers are of different specialties, regardless of the credential. I've also encountered cases where two providers may be of the same specialty as enrolled with the payer, but may have different sub-specialties (for example, a general dermatologist and a dermatologist who is a Mohs surgeon) and in these cases, the payers will general deny the second claim on the same date, but some of them will allow you to appeal the denial if you can submit documentation that shows the different sub-specialties of the providers and that the two services were both medically necessary.