Forum - Questions & Answers

Mar 15th, 2010 - carole0403

Two E/M Visits/ Two Specialties/ Same disgnosis and Date of Service

If two physicians from two separate specialities see the same patient on the same date of service and bill an E/M serivce, can they both bill using the same primary diagnosis and expect to be paid by Medicare?

Example: A hospitalist is attending a patient that he/she has diagnosed with chronic pulmonary edema upon admit for which he/she bills a 99222AI. He calls a pulmonary specialist in for an opinion/confirmation on the same date of service and the pulmonary specialist bills a 99223 with the primary diagnosis also as chronic pulmonary edema. Can both the hositalist and the specialist expect to submit these charges and be paid by medicare?

It's been difficult to locate anything in writing on this. If anyone can answer my question an point me to medicare's guidline I will appreciate it.

Mar 16th, 2010 -

I have no reference but...

They both should get paid for the initial visit even if on the same day. Now you may get a rejection on subsequent visits as there is no medical necessity for two docs to treat the same condition.

Mar 17th, 2010 - Codapedia Editor 1,399 

two "initial hospital services" same day

If you look at the articles on how to bill consultations, you'll find the MedLearn Matters article from CMS you'll see the instructions on how to bill for consults. So yes, you'll find the citation that says you can do this.



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association