ED Coding and Reimbursement Alert

Question: What services can nurse practitioners (NPs) bill for when they treat patients in the ED?

Utah Subscriber  
Answer: Generally speaking, NPs are allowed a wide range of responsibilities in the ED, depending on their training and level of experience. Specific duties are regulated by state practice law, however, and each ED must determine what is appropriate. In addition, the collaborating physician (or, in the case of a physician assistant [PA], the supervising physician) and the hospital itself may limit the nature of services NPs are allowed to provide (e.g., specific types of surgical procedures). Frequently, NPs report the appropriate level of E/M services (99281-99285), as well as initial observation care (99218-99220) and observation discharge services (99217). Likewise, they may report specific, approved procedures like placement of a peripherally inserted central catheter (PICC) line (e.g., 36489, Placement of central venous catheter [subclavian, jugular, or other vein][e.g., for central venous pressure, hyperalimentation, hemodialysis, or chemotherapy]; percutaneous, over age 2).
 
Within this context, reimbursement will depend on the payer. Medicare places no formal restrictions on the types of care a nonphysician practitioner (NPP) can provide, although services must be reported under the NPs provider identification number. Claims will be paid at 85 percent of the physician fee schedule. Incident-to billing does not apply in a hospital setting. Medicaid policy differs from state to state. The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) issues NPP provider numbers, and payment is not changed. Commercial health plans usually do not enroll NPPs, such as NPs. Claims for their services are sent under the supervisory physicians name.