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  1. If a hospital employed cardiothoracic surgeon performs a major surgical procedure with a 90 day global period and following surgery admits the patient to the critical care unit, can critical care services in the postoperative period, if appropriately documented, be reported by hospital employed NPP who have a different specialty code than the cardiothoracic surgeon?

    Answer:
    If the NPP is working within the cardiothoracic practice, and the care is related to the patient’s postoperative status relative to the surgical procedure, then this care is bundled into the surgical payment package. If, on the other hand, the NPP is working for the renal group and addressing renal failure unrelated to the surgery, the care may be separately payable. Updated 8/29/2017
     
  2. Should each MD in the same practice bill with two different taxonomy codes based on whether functioning as a cardiologist or electrophysiologist?

    Answer:
    Yes, providers should be billing with their taxonomy codes. The claim system will pull the correct PTAN for each specialty. Cardiac electrophysiology has been assigned specialty code 21. Providers of this specialty should update their enrollment files to reflect this specialty. Please refer to the information provided in CMS MLN Matters article MM7209: New Physician Specialty Codes for Cardiac Electrophysiology and Sports Medicine. Updated 6/9/2017
     
  3. There are times in which a NP or PA from one of our departments, i.e., internal medicine, sees a new patient and then refers the patient to one of our other specialists i.e., gastroenterology.  If that patient is also new to that specialty, and is seen by the NP or PA, we bill a new patient visit.  When we bill this way, we are receiving denials from Medicare citing the new patient rule in that the patient was already seen by the same provider of the same specialty within the same group.

    Answer:
    CMS designates one specialty code for NPs (50) and once that specialty code is linked to a new patient visit by a group member, other first visits billed by NPs in the group cannot be paid as initial care. It is permissible to bill these services as subsequent visits, since they are considered as subsequent care by a same-specialty provider in the group. Updated 6/9/2017

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