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CAPC Palliative Care Discussion Forum
Billing and Finance

Next Reply: Re:Setting up billing so PC svcs separate from IM
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Post Setting up billing so PC svcs separate from IM
Author: alh
Date: Sep 11, 2008 1:47 pm
Hello, our hospital currently has the palliative care physicians listed under the billing umbrella of internal medicine. They tell us currently for billing there is not a subcategory for palliative care. There is geriatrics. Is this universal to most hospitals? Is the because there is yet to be a subspecialty PC under medicare? Our consult and daily followup billing is getting rejected by insurers because our palliative care physician is under the same tax ID as the Hospitalists. How do other programs set up the billing internally so when submitted it does not look like two docs from the same group?
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Re:Setting up billing so PC svcs separate from IM (by SharolHerr on 09/19/2008)
Per Dr. Philip Santa-Emma our Palliative/Hospice Medical Director:
This can be confusing. When physicians bill, they bill with a unique identifier, which may reflect a group practice. It does not matter if it is internal medicine, fam med or surgery. What is happening is that only one physician from the group can bill per day, unless the 77 modifier is used, as Lynn stated in the conference call.
Sharol Herr, RN, MSEd: Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.
Re:Setting up billing so PC svcs separate from IM (by PCaines on 09/23/2008)
The below reply comment is provided on behalf of:

Julie Pipke, CPC
Reimbursement Manager, Medicine
Medical College of Wisconsin

You cannot make the services look like they are from different groups; you have to make them look like they were for unrelated reasons. The only way that can happen is when the providers bill their services with separate diagnosis codes (our guidance has been that the first three digits must be different). Not only do you need separate diagnosis codes you should also append the 77 modifier to both services. If you cannot get the modifiers on up front prior to claims submission, add the modifier once you have been denied and request an appeal.


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