May 29, 2014
I am new to credentialing at my clinic. We have 3 ENT doctors and a new physician joining the practice in the next few months. The new physician is a Pediatric Otolaryngologist. I am starting the initial paperwork, but can’t find a specialty code for Pediatric Otolaryngology. Should I credential him under Pediatrics? Also, since he is a different specialty, can I bill new patient codes for any of our patients that have been seen in the practice by another physician who isn’t a pediatric otolaryngologist? The other otolaryngologists in our group refer the pediatric patients to the new physician.
Thanks for your questions. Unfortunately, payors do not recognize the subspecialties of Otolaryngology. Even though your new doctor is a pediatric otolaryngologist, he is considered an Otolaryngologist like the rest of the physicians in your practice.
Because there is not a separate distinction for subspecialties in Otolaryngology, all physicians in the same tax ID are considered part of the same group. If a patient was evaluated by a physician of the same specialty (otolaryngology) in the same group within the last three years and is now being evaluated by your new pediatric otolaryngology physician, the service would be billed using an established visit code (9921x).