Otolaryngology Coding Alert

Can a nonphysician request consults? The answer may surprise you You might think you-ve got nonphysician practitioner (NPP) coding down pat, but the regulations change so frequently that you should test your skills from time to time. Take a few minutes to challenge yourself with our NPP coding quiz and make sure you-re on the right track. Established Patient, New Problem: Is It Incident-To? Question 1: Your nurse practitioner (NP) meets with an established patient to replace the patient's surgical dressing, which got wet during a boat trip. When the NP removes the wet dressing, he discovers a deep skin infection that formed under it.

The otolaryngologist is in the suite but is unable to come into the examining room to evaluate the new problem, so the NP debrides the wound and gives the patient an antibiotic prescription. Can you bill the visit incident-to, or should you bill it under the NP's provider identification number (PIN)? Answer 1: -This visit must be billed under the NP's number and is not an incident-to visit,- says Ron L. Nelson, PA-C, president of Health Services Associates in Fremont, Mich., and past president of the American Academy of Physician Assistants. -This is clear-cut, and based upon the regulations it would require the billing to be under the NP's number,- he says.

Here's why: Even though the NP saw an established patient, the visit doesn't qualify as incident-to because the physician should see the patient for any new problems. If the NP addresses the skin infection (a new problem) without the physician's input, the NP should bill the visit using his own PIN.

The incident-to guidelines require the physician to see any new patients or any new problems that the patient has. Your NP can still bill the visit, but he must do so using his own identification number. Can an NPP Base the E/M Level on Time Spent? Question 2: A patient who was diagnosed with cholesteatoma three weeks ago reports for a follow-up visit. The physician assistant (PA) draws blood for lab work and talks to the patient about her severe anxiety, lack of sleep and depression since she was diagnosed. The discussion takes 15 minutes, and the total visit takes 26 minutes. Which level of E/M service is it appropriate to report?
 
Answer 2: During E/M visits in which the PA must provide a lot of extra counseling to a patient, you may be able to determine the E/M level based on time -- if counseling and/or coordination of care dominated the encounter time and you properly document the visit. On your claim, you should:

- report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at [...]