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Patient is admitted and discharge on same day by two different providers who belong to the same group practice …
Provider who admitted patient to observation is the one who gets billed with 99234-36 .. ??
Is that correct?
Help please! :confused:
I spoke with the Maternity Care group that pays for AL Mediciad OB Global to ask how to bill them and was informed that the physician will have to bill the OB Global and the NP will need to be reimbursed from that office. I believe that we need to bill all payers this way.
We had an OB/GYN that left last July so all his patients had to transfer. I had to do a lot of antepartum billing for him. Certain payers such as BCBS denied the claims requiring me to list the Antepartum span dates from the First (New) OB visit to the last visit. Under this new set up, we will have overlapping dates of service between the two pactice locations. The NP will see the OB patients from the New OB until 20-24 weeks. The patient will go to the Physician’s office one time between 20-24 weeks then back to the NP. The patient will be treated by the NP until 35 weeks. At 35 weeks and after, they will go to the Physician’s office until delivery. Since we will have overlapping dates, I cannot enter these dates on the claim, since the claims will deny for overlapping services.
Originally, this was supposed to be Cash pay patients that only had Emergency Medicaid that would cover the delivery. We would charge a set cash price for each antepartum visit (at either office) and the physician would bill Mediciad for the Delivery. Our set up is fine in this situation.
Now, they are marketing to patient’s in the (rural) area that have insurnce and BCBS is a big provider in the area. This has now complicated the OB Global billing, since we have two separate locations under different NPI/Tax ID’s. Help!
I believe that all insurred patients should be billed by the physician and that office have a contract on what to reimburse the NP services for. I need confirmation for this, and I have a feeling that this type of set up has not been done before which makes setting up the charges and billing for this a bit challenging.
I appreciate any help I can get.
Rose Patterson :confused:
the Nurse Practitioner charged New Patient E/M for the morning appt, MD wants to charge for Established Patient E/M and the aspiration for the afternoon. my question is can this be done? or should we just bill for the procedure in the afternoon and the Office visit in the morning. can i use modifier 57 for the afternoon E/M?
any advice will be greatly appreciated
thanks
Thanks in advance
If one of our PA’s or NP’s sees patients in a nursing home outside of the office setting for medication management (E/M) what CPT codes would be used and would there be modifiers needed?
In the office setting we would normally use the E/M codes, so would these still be used (99211-99215) with modifiers in the nursing home(assisted living facility)? Or should the nursing facility services codes be used? Which CPT codes should we be using?
Some of our physicians are general surgery. Sometimes we perform all of the aspects of care during the patient’s stay such as the inital visit, the surgery with follow up care.
Sometimes, a different general surgeon from a different group performs the initial visit and surgery, and when we are on call during the week or weekends, we follow up with the patient, so I figured I would bill for this visit, knowing they are in a global for the surgery, but the patient’s surgery was not performed by us. When we bill these charges out, we are hit with the denial "Benefit for this procedure/service is included in the payment/allowance for another service/procedure that has already been adjudicated.
I have researched and researched. I can not find anything that addresses this problem. I am wondering how other practices handle this. If we see that the patient is seen by a different surgeon in a different practice and the patient had surgery with the other surgeon, do we just cut our loses? That doesn’t even seem fair. Is there another modifier that we can use? Can we use 27 modifier?
If you have input, I welcome it.
Thanks so much
Beth
Thanks,