Q&A E/M Covering On-Call Service

[jmhaduck]

I just took my chapter 19 Review Exam and I had a question below that I would like some clarification on.

Question:

A patient is seen by Dr. B who is covering on-call services for Dr. A. The patient is an established patient with Dr. A. but she has not been seen by Dr. B before. Which E/M subcatergory is appropriate to report the services provided by Dr. B?

Answer:

According to the E/M guidelines for New and Established Patient, when a provider is on call or covering for another provider, the patient’s encounter will be classified as it would have been by the provider who is not available. In this instance, Dr. B would report an established patient office visit.

I used to work for a doctor (solo practitioner) and he along with a few other solo practitioners would cover on-call for each other. When my doctor reported his E/M code he would use a new patient code (unless he saw them before). These visits were paid. These doctors were not in the same practice either.

I just want to know if this is correct and I should have assumed that the above question doctor was in the same practice????

I hope you can answer this question at tonight’s webinar.

Thanks in advance! I am enjoying your Blitz videos. Getting nervous about taking my certification exam at the end of June.

Jennifer

 

[Laureen]

Hi Jennifer,

This statement is correct "According to the E/M guidelines for New and Established Patient, when a provider is on call or covering for another provider, the patient’s encounter will be classified as it would have been by the provider who is not available. In this instance, Dr. B would report an established patient office visit."

So they way your solo practitioner was doing it was incorrect. They were paid because the payer didn't catch it.

Basically when a physician is covering they are seeing the patients as if they were the other doctor - everything gets billed under the "real" doctor.

Here is a detailed article http://news.aapc.com/get-the-most-out-of-locum-tenens-physicians/

 

[jmhaduck]

Thanks Laureen! I appreciate when you put links to articles and websites to refer to.