Q:
I have a patient encounter where 2 different providers working in our urgent care clinic completed orders for the same patient encounter. I rarely see this type of documentation and I believe it happened because of shift-change during the encounter. The first provider completed the majority of the visit, ordered a prescription and signed the note. The 2nd provider ordered some lab tests. Can we give the first provider credit for the lab work when determining the E/M level?
A:
In the encounter you describe, most payers consider the two providers working as one – Medicare does, and most payers adopt the same policy. Be sure to check payer policy. In this case, the work is combined and billed under one clinician. The information pasted below is from Medicare’s Claim Processing Manual, 100-04, Chapter 12, Section 30.6.5, https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs (See also Section 30.6.1 on a Shared E/M Visit although your scenario is most likely not appropriate for a shared visit.)
Physicians in Group Practice: Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.