The Proper Way to Code Two Services in the Same Group

Q: What is the proper way to code two services in the same group by different providers specialties on the same date. Example a psychiatrist and a PCP in the same group seeing the same client on the same DOS (date of service).

A: Hey! That is really a great question. That’s a practical question, not one you necessarily going to see on an exam. What do you think, Schuyler? Or did you have this one already?

Coach Schuyler: Answered already.

Coach Jennifer: Well, what’s your answer, Schuyler?

Coach Schuyler: Well, the E/M guidelines specifically state, especially for established patients, that if it’s within the three-year time period and it’s in the same group, same specialty, it still uses that established E/M visit. Now, there’s this different specialty, maybe the same group but different specialty, so there are different E/M levels. Psychiatrists – it may be more of a psychotherapy note. So obviously that enough itself is a totally different E/M.

Coach Alicia: So it’s not going to be a problem. OK. So what if you have a cardiologist seeing a patient and the PCP, same thing, because they’re two separate specialties?
Coach Jennifer: Another key point there on my end, on the billing end, they have to be listed with the insurance carrier as different specialties. In our office we’re orthopedic and we could have somebody come in who might be a podiatry specifically but working with the orthopedic group. They have to be listed as a different specialty. I mean, those are two closely related. I won’t even attempt that one. But a psychiatrist and a PCP, as long as they’re listed as different specialties with the insurance carrier, of course they have to have different notes. They can’t borrow one person’s notes for their…

Coach Alicia: Copy and paste. Yeah.

Coach Jennifer: There’s none of that copy-paste. Nothing. So as long as they have their own distinct separate visits and they list it as different specialties, they can bill two services.

Coach Schuyler: There’s one thing to note about psychotherapy notes. When it comes to release of information, there are certain things in different states in which they have to get approved by the patient itself. They can sign even if they had any alcohol therapy notes or new psychotherapy notes, that can be more protecting, they cannot share that information.

Coach Jennifer: That’s true. Yeah.

Coach Schuyler: There’s one that’s very special that those would definitely have to be kept separate in the event that that patient does not want that information being sent out. If a provider does that, shame on them but they’re going to be going through a lot of issues.

Coach Jennifer: Yeah.

Coach Alicia: That’s a really good point. I think we are still trying to catch up with mental health. Now that mental health is being covered by the payers more than ever before, that just puts us on an even higher learning curve trying to do that.

With this question I’m thinking of these small physician groups. I guess they’re not really small, but when were in Texas over in San Angelo, you had Shannon Health and you had another group, another hospital, but they also had an ancillary physician group that was connected to the hospital but they were their own entity in it of themselves. There were several specialties in there. I can see how, like you said, if you go to a cardiologist but because you live out in the country, you don’t want to keep going to the doctor so you’re going to go get your diabetic foot checked by the podiatrist the same day, stuff like that. But that’s two separate specialties, so they would bill separately and then make sure that the insurance knows that they are specialties.

At the bottom of the CMS 1500 form where you put the provider’s name and their number, is that not enough? The payer has to have them listed as well?

Coach Jennifer: You have to be listed separately with the payer. Yeah. Because even under your NPI when you go to the NPI data back and stuff, they list specialties. You got to remember that number, it stays with them forever. So when they’re a resident, they have that number. Then when you go on to a specialty, so those things have to be updated and changed. Somebody did ask. There’s two more questions that have come in about the same thing, a modifier 25, Deborah asks.

No. Remember, what’s modifier 25? Separately identifiable procedure.

Coach Alicia: Yeah. Not provider.