Wiki Billing for different specialists in same group

nan.coder

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Where can information be found on the CMS website concerning same day E&M billing for two difference specialists (of course with different taxonomy numbers) within same multispecialty group sharing one tax identification number?

Thank you in advance.

Nancy Boyle, CPC CRC
AAPC St Louis Chapter
 
This happens to me a lot. I code radiation oncology, and it's not unusual for a patient to have an appointment with the medical oncologist and the radiation oncologist on the same day. Makes sense - the patient only has to make one trip to the office. Some of our patients travel quite a distance, and 2 visits would be a hardship for them.

99.9% of the time the visits process without any issue. Once in a blue moon I'll get a denial for a duplicate visit. Of course, the patient seeing the med onc about chemotherapy and the rad onc for a radiation consult are not duplicates.

Ultimately they get paid, it's just an extra hassle having to reiterate why it's not a duplicate. Thankfully that's only a small percentage of claims.
 
If you are talking office/outpatient there is a reference here:
30.6.7 - Payment for Office or Other Outpatient Evaluation andManagement (E/M) Visits (Codes 99202 - 99215)
B. Office/Outpatient E/M Visits Provided on Same Day for Unrelated Problems As for all other E/M services except where specifically noted, the Medicare AdministrativeContractors (MACs) may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office, off campus-outpatient hospital, or on campus-outpatient hospital setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident).

Some of the MACs have E/M FAQ like Novitas: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00005056
2. Is it possible for the same physician to bill and be paid for a second E/M service on the same date of service for the same patient?
If a second E/M service is required on the same date of service, the documentation should clearly provide evidence of the second E/M service occurring, the reason for the additional E/M service, and documentation of the medical necessity of the second E/M service. When reporting a second E/M service on the same date, the service will initially deny as only one E/M is reimbursable per day, per patient, per physician or same group, same specialty You may appeal the denial with documentation. Novitas Solutions would not expect to see two E/M services reported on the same date on a routine basis.

This specifically answers your question: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
5. Can two physicians in the same group practice, who see the same patient on the same day, each bill for an E/M service and receive payment?
Physicians in the same group practice but who are in different specialties may bill and be paid separately without regard to their membership in the same group.
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.
 
This happens to me a lot. I code radiation oncology, and it's not unusual for a patient to have an appointment with the medical oncologist and the radiation oncologist on the same day. Makes sense - the patient only has to make one trip to the office. Some of our patients travel quite a distance, and 2 visits would be a hardship for them.

99.9% of the time the visits process without any issue. Once in a blue moon I'll get a denial for a duplicate visit. Of course, the patient seeing the med onc about chemotherapy and the rad onc for a radiation consult are not duplicates.

Ultimately they get paid, it's just an extra hassle having to reiterate why it's not a duplicate. Thankfully that's only a small percentage of claims.
Thank you.
 
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