Wiki Clarification on inpatient billing when patient see's 2 MD's

[tsjob17]

I'm confused, I've been told I'm billing this correctly and then I'm told I am not. So here I am trying to get more feedback on this. A little background, I work in a group practice and on a typical day we have 1 provider assigned to the outpatient clinic, 1 provider as the consult doctor and 1-2 as the inpatient providers.

Scenario: Patient has AML and has been admitted for induction chemotherapy. On one of the days during the inpatient stay the inpatient provider (Dr. A) came in and saw the patient for the typical subsequent hospital care, met the criteria of 99233 with 60 min spent in care of the patient and addressed all the current issues going on. BUT the patient also had time set asided for a Treatment Planning Conference with the consult provider (Dr. B). Dr. B met with the patient to discuss not only chemotherapy treatments available, but also discussed having an allogenic stem cell transplant. Dr. B spent 90 min with the patient.

I had coded Dr. A with CPT 99233 and Dr. B with the prolonged codes of 99356 & 99357. This is how I was initially instructed to bill as they are providing different services, even though we are one group practice.

Now I am told that for this scenario I need to bill under one provider, like this:

• 99233
• Billing Provider: Dr. A
• Actual Provider: Dr. A
  
• 99356, 99357
• Billing Provider: Dr. A
• Actual Provider: Dr. B

Thoughts

 

[sande78705]

Cms guidelines are very specific. In the claims processing manual it states that there should be only 1 visit per day from the group, but there are some exceptions. The cms manual is very helpful and just do a search of your question and you should get the information you need.
Suzanne

 

[tsjob17]

Thank you Suzanne! I didn't even think to look there, that did help.