Can A Primary Care Doctor and a Hospitalist Bill On The Same Day?

A reader asks me the question. Can a hospitalist and the primary care doctor bill on the same day?

That's a great question. The answer is, anyone can bill. The question is can you collect? With that said, the answer is sometimes yes and sometimes no. Here is my understanding:

Generally speaking, two physicians from the same like specialty cannot both collect from the patient's insurer for similar services on the same calendar day, even if they are from different practices. In other words, most insurers, if they are paying attention, will not pay for two internal medicine doctors or two gastroenterologists or two infectious disease docs to round on the same patient on the same calendar day if they are providing like services within the same scope of practice.

If the hospitalist rounds on the patient and the primary care doc comes by and rounds on them as well and they both submit a hospital follow up charge 99231-99233, if the insurance company is paying attention (which they may not be), they will likely deny the charge submitted second as medically unnecessary.

There is one situation where billing by two physicians in the same specialty but different practices are allowed.

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If a primary care doctor sees a patient in the office and admits the patient to the hospital, they can only bill one charge. Either the clinic visit (99211-99215) or the hospital admission code (99221-99223). Most insurance companies will not allow the same physician to submit both E&M codes in the same calendar day. But if the primary care doc sees the patient in their clinic and they have a hospitalist admit, then the primary care doc can submit a 99211-99215 clinic code and the hospitalist can submit a 99221-99223 hospital admission code and both will get paid. Because both docs are providing medically necessary care independent of the other.

As far as I know, if a hospitalist admits a patient after midnight and the primary care doc comes by later that morning and tries to bill either another H&P or a follow up code, it will likely get denied (depending on who submits the claim first) as medically unnecessary. Most insurance companies, that are paying attention, will not allow multiple claims from different docs in different groups but of the same specialty on the same calendar day.

Our group generally will only admit patients we see till the end. We don't admit over night for the convenience of the primary care doc so they can take over in the morning. We have established our program as one that does not do that. If you want us to take care of your patients, we will. But we won't do it just so you can sleep at night and work in the days.
You can learn more about coding here in my coding lectures or earn CME at E&M University