Wiki Same tax id different specialty dame day

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sgaskill

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We are a multy specialy facility I cant seem to find a straigh answer on how to get our Dr paid. Our Dr is a general practice Dr. He admits a Patient and then a cardiologist (for example) from the same tax id does ekg follow ups and such same day and next day. We are billing our general practice Dr 99222, AI and we are not getting paid because cardiologist billed an EKG. the cardiologist is getting paid not the admitting phys. Medicare insists they only pay one dr per day of service eventhough DR's have different specialists......Please Help!!!!:eek:
 
I would think you would need 25 mod on initial visit. check out medicare processing claim mamual 30.6.5
 
What service is the cardiologist getting paid for? Just the EKG? An admit or sub day? Are the PCP and Cardiologist using the same primary dx?
 
ummm

That doesn't sound right. If the Cardiologist and General Practice have the same tax id that should be fine they should have different NPI numbers.. I do hospitalists, neuro, pulm, and urgent care. I do this all day long, my hospitalists will admit a patient and I bill a 99222 - AI, and then when neuro or cardio or whatever other specialty comes in to see the patient they are a different specialty, so they get paid. They all have different NPI numbers. You may want to look up the doctors NPI numbers and see if their NPI'S are listed under the same speciality.. I bet that is what the issue is. Here is the link to check their NPI #, if the cardiologist and the general practice phys have the same NPI they can't both bill on the same dos, only one can.

https://nppes.cms.hhs.gov/NPPES/Welcome.do
 
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