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peeya

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I need help with a situation in the office

There are two cardiologists with seperate tax id's involved in this situation.

Cardiologist#1 sees the patient & refers him to cardiologist#2 for pacemaker / ICD implants.

Cardiologist#2 sees the patient on the same day & bills for a consult/new patinent visit.

My question is that is there any way Cardiologist#2 will get paid for the visit?
 
I can't say for sure that he would get paid since they are the same specialty however, they are billing under distinct and seperate TX ID's, so Cardio #2 may have no problems.

Are they in seperate entities as well?

I would try to get paid on both. They both did the work and want to be paid and have the seperate id's. We have cardio's that only see patient's and the cardio's that do the procedure (Interventionalist) but they are all under the same TX ID so we can't bill your situation, however, you may be just fine. I just wonder if the insurance will deny based on the fact they are both of the same specialty so it might not make any sense to the insurance why patient was referred to another specialist of the same specialty.

My two cents for what it's worth. Happy Friday!
 
jewlz0879 said:
I can't say for sure that he would get paid since they are the same specialty however, they are billing under distinct and seperate TX ID's, so Cardio #2 may have no problems.

Are they in seperate entities as well?

I would try to get paid on both. They both did the work and want to be paid and have the seperate id's. We have cardio's that only see patient's and the cardio's that do the procedure (Interventionalist) but they are all under the same TX ID so we can't bill your situation, however, you may be just fine. I just wonder if the insurance will deny based on the fact they are both of the same specialty so it might not make any sense to the insurance why patient was referred to another specialist of the same specialty.

My two cents for what it's worth. Happy Friday!
Click to expand...

My quick question on this, are the two Cardiologists in the same group? If so, I don't think the second doc can get an E&M, but can get paid for the procedure.
Happy Friday!
Jim Pawloski, CIRCC
 
Jim Pawloski said:
My quick question on this, are the two Cardiologists in the same group? If so, I don't think the second doc can get an E&M, but can get paid for the procedure.
Happy Friday!
Jim Pawloski, CIRCC
Click to expand...

No they are not in the same group. They are in two seperate groups
 
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