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Otolaryngology Coding Alert

READER QUESTIONS:

NPPs Can Bill in Hospital--Just Not 'Incident-To'

Published on Mon Jun 19, 2006

Question: In your April article -Your Consult Documentation Needs Immediate Revision: Here's Why,- you said that nonphysician practitioners (NPPs) cannot provide consults in the hospital setting, but our insurer allows this. Are we billing incorrectly?



Texas Subscriber


Answer: If you report the inpatient consults under the NPP's own provider identification number (PIN), you are billing correctly.

Most insurers allow you to report services that the NPP provides in a hospital setting, as long as you don't report the services -incident-to.- Therefore, if your NPP provides a consult in the hospital and documents the -three R-s- of the consultation (request, review, and report back to the requesting physician), you can report the appropriate consult code (99241-99245 or 99251-99255 depending if the patient is outpatient or inpatient) under the NPP's PIN.

Caveat: Always check your state and hospital scope-of-practice guidelines before you bill an NPP's consult services, because state guidelines can vary throughout the country.



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