Wiki Taxonomy Codes for Different docs/Same practice

[nics1011]

A few questions have recently come up in our seven physician Orthopaedic practice....Any help with this would be greatly appreciated!

1. Does anyone know if Medicare recognizes the tax ID or taxonomy codes when looking at claims?

2. Can a physician in a practice charge for a consult for a patient who has previously been seen/charged for by another physician in the same practice IF they have different taxonomy codes.

For example,

Dr. Smith, a sports medicine physician, refers a patient to Dr. Jones, a hand specialist for a consultation in the hospital. Both physicians are from the same Ortho practice and therefore are billing under the same tax ID; however, they have different subspecialties.

Thank you in advance!

Nicole

 

[dclark7]

Medicare recognizes Orthopedic Surgery, Hand Surgery and Sports Medicine as three different specialties but the physician must have listed one of these as their Primary specialty in order to be considered a separate specialty from another physician in the same group. So in other words, if Dr. Smith and Dr. Jones have both listed Orthopedic Surgery as their primary specialties and then Sports Medicine or Hand as the secondary, they are both considered the same specialty by Medicare. If you reverse that and Dr. Smith is credentialed with Sports Medicine as his primary Ortho Surgery secondary and Dr. Jones has Hand as primary with Ortho surgery secondary then they are considered different specialties.

You would have to check with other carriers on their specific credentialing policies.

 

[nics1011]

Thank you!!