Can A Primary Care Doctor (PCP) 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 will not pay for two internal medicine doctors or two gastroenterologists or two infectious disease doctors to round on the same patient on the same calendar day if they are providing like services within the same scope of practice. However, at this link, I have reviewed how the same doctor or two doctors in the same specialty and group can bill two E/M charges in the same day.  

If the hospitalist rounds on the patient and the primary care doctor comes by and rounds on them as well and they both submit a hospital follow up charge, one charge will likely be denied.  There is one situation where  coding by two physicians in the same specialty but different practices are allowed. 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 or the hospital admission code.   Most insurance companies will not allow the same physician to submit both E&M codes in the same calendar day.

However, if the primary care doctor sees the patient in their clinic and they have a hospitalist admit, then the primary care doctor can submit a clinic code (review the AMA's CPT 2015 Standard Edition as the definitive CPT authority)  and the hospitalist can submit a  hospital admission code and both will get paid because both doctors are providing medically necessary and different care independent of the other.

If a hospitalist admits a patient after midnight and the primary care doctor comes by later that morning and tries to bill either another H&P or a follow up code, one of the charges will likely get denied as medically unnecessary.  Relationships between the PCP and the hospitalist should define the role of both.  Many PCPs may make social rounds to stay in contact with the patient but defer documentation an billing to the hospitalist.  This practice is common.  Some hospitalist groups admit the patient at night and turn over care to the PCP who then bills for their services.  This type of arrangement is often made contractually or by handshake.

Ultimately, the two parties should agree on who is going to bill and who is not.   Most insurance companies will not allow multiple claims from different doctor in different groups but of the same specialty on the same calendar day if the services are of similar nature.   You can see much more in my free lectures on E/M hospital coding.  Make sure to also review the wealth of information available in my hospitalist resources section.  


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7 Outbursts:

  1. What if the hospitalist and the primary care physician have the same tax id?

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  2. My inclination is to say no. I assume in this situation this is a group practice where the patient is seen in the hospital as a clinic visit and then admitted to the hospital and an H&P is done. As far as I know, the two docs would be treated as one.

    However, I have heard that if you submit two hospital follow up codes in the same day by two different hospitalists in the same group, the claim my be denied, but some may pay if you resubmit with support documentation that indicates the patient was seen for different problems/ICD codes.

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  3. Can you bill for critical care time without billing for subsequent visit on given calendar date??

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  4. vipul. of course. In fact, you can bill critical care codes 99291 and 99292 on any day in any site (you don't have to be in the ICU to bill critical care codes but being in the ICU doesn't mean you can bill critical care either).

    In fact you can bill an E&M code (admit codes 99221-99223 or hospital follow up codes 99231-99233 and if the patient gets sick later in the same calendar day and their illness rises to the level of critical care and you spend at least an additional 30 minutes, you can also submit critical care codes 99291 or 99292 on the same day you submitted your admit or follow up codes.

    Now, what you can't do is bill a critical care code 99291 or 99292 and then later in the day bill an admit or hospital E&M follow up code. If you spend more time on the patient in the same calendar day, you would bill additional 99292 codes for additional time.

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  5. Can an ER Physician and a Hospitalist both bill for 99291 for the same date of service?

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  6. anon 2:04. Yes they can. Technically, Medicare rules state that the time physicians billing critical care codes 99291 or 99292 can't overlap, but in reality, I've never seen a claim rejected for that reason.

    Why should it. If two physicians are doing critical care work, both should get paid for the work they are doing.

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