Wiki EP Specialty

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rbrister

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Since CMS now recognizes Cardiac Electrophysiology as a specialty, does anyone know if it is ok for our EP docs to start billing New Patient visits or Consults, depeneding on insurance, if one of our regular Cardiologists in the same group refers a patient to them? I have gotten conflicting information from Medicare and was told that Blue Cross doesn't recognize the EP specialty yet. Anybody have any experiance with it yet?
Thanks!
 
In order for Medicare to pay your EP claims, the physician should have submitted an application to Medicare changing their specialty from Cardiology to Electrophysiology. If the change is not done, your EP will not get paid on new patient visits. As far as other payers, you would have to check with them and ask if EP is recognized as a separate specialty.

good luck,

Dolores, CCC CPC
 
We have already changed their Specialty with Medicare to EP. I was still told that because the physicians are in the same clinic billing under the same Tax ID that the EP physician couldn't bill a NP code. I don't think that is correct, but have not tried it yet. Do you think our EP physicians should be able to bill a NP code for consults?

Thank you!!
 
If credentialed as EP docs then you can bill a NP visit as long as no other doc in group seeing the same patient is also an EP doc. You may have to appeal some of them but they will get paid. Once the NP visit is billed for that EP doc, all E/M rules fall into place. Hope this helps.
 
CMS has always recognized EP as a subspecialty of Cardiology but has only recently created a specialty code for these providers. EP physicians can update their taxonomy status on the NPPES website showing primary specialty as EP. Yes, a cardiologist may refer a pt for an EP consult within their clinic as well as during an In-pt hospital stay. These are separately billable, but as others have stated, you may have to work a little harder to get these paid. It has been easier since CMS created the new specialty code (21).
 
you shoul'd have no problem in getting this paid but most do have to be appealed and if you stste in the appeal why the patient was seen by the EP doc and that this was the EP docs first f/f with the patient it will get paid. As for other payors we have to appeal as well but they are also being paid on appeal.
 
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