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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
Can anyone who does pediatric specialty work share with me any good bench marking and auditing resources? The group I work with does pediatric: ortho, endo, hem/onc, GI, rheum, genetics, neurology, neurosurgery, developmental, psych, and pulm and are still growing in specialties. I’m used to working with adult medicine and being able to get resources easier than I am finding them on the peds side.
Thank you
In most states, you can run a free standing substance abuse facility with a medical director of any provider specialty. However the standards of care for both United Healthcare and Cigna state that initial psychiatric evaluations have to be done by a board certified psychiatrist or addictionologist. I have heard that Cigna also allows the initial psych evals can be done by a specialized psych ARNP.
So here are my questions. Would it be okay for a psych ARNP to provide the initial face to face psychiatric evaluation? If so, can they report to a medical director that has a scope of practice outside of Psychiatry or Addictionology?