physician billing - Concurrent care

Concurrent Care 

Concurrent care exists when certain evaluation and management (E/M) services are rendered by more than one physician with the same or similar specialty on the same date of service. Reasonable and necessary services of each physician rendering concurrent care could be covered when each is required to play an active role in the patient ’ s treatment -- for example, due to the exis- tence of medical conditions requiring diverse specialized medical services. 

To find concurrent physicians ’ services reasonable and necessary, the carrier must determine:

* If the patient ’ s condition warrants the services of more than one physician, with the same or simillar specialty, on an attending (rather than consultative) basis; and

* If the individual services provided by each physician are reasonable and necessary. 

Before determining payment, carriers consider the physician ’ s specialty, as well as the patient ’ s diagnosis.

Physician specialties indicate the necessity for concurrent services, but the carrier ’ s medical staff must also consider the patient ’ s condition and the inherent reasonableness and necessity of the services. For example, although cardiology is a sub specialty of internal medicine, the treatment of both diabetes and a serious heart condition might require the concurrent services of two physicians, each practicing in internal medicine but specializing in different sub specialties.

A patient may occasionally require the services of two physicians with the same specialty or subspecialty, if one physician has limited his or her practice to a unique aspect of that specialty. If the medical documentation does not substantiate the need for more than one physician ’ s service, payment will not be made for the other physician ’ s services.


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