Wiki Er professional fee vs inpatient

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josiew3

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If a patient is seen in the ER and the physician decides they need to be admitted and turns them over to the hospitalist to be admitted, can I charge for both physicians if they are under the same group NPI number?

I know if the ER physician admits the patient I can not charge for both but only the Inpatient initial charge----however, these are two different Docs, using the same NPI...is it double billing?
 
a physician of a different specialty can bill his/her own E/M for the same date. But your scenario as described, no, because they are the same group NPI and I assume the same specialty. Why would Dr # 1 turn the pt over to a hospitalist to admit the pt if Dr # 1 did the H & P and decision to admit to inpatient? He's shooting himslef in the foot and missing out on revenue. If he has admitting priviledges he needs to bill the admit himself. (and if the pt was admitted into "observation" status then append AI modifier to the claim). I have read where some coder combine the charting on the 2 providers that want to bill an e/m on the same date that are of the same specialty. But internally their private office would probably want some sort of agreement written as to how they'll share the reimbursement for the service...
 
ER physicians and hospitalists generally are of different specialties (emergency medicine vs. internal medicine) and the work is different - emergent treatment and stabilization of the patient vs. the work of admission to the hospital and planning the course of care. I think when you say the ER physician 'decides they need to be admitted', they are not actually admitting the patient, just referring them to the hospital for care, at which point the ER physician's work is done and the hospitalist's begins. We've never run into problems with denials or audits by billing these two services as separate and distinct, but our specialties are different. If you have internists working in the ER or ER docs working as hospitalists, you could run into problems.
 
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