Part B Insider (Multispecialty) Coding Alert

Published on Mon Nov 20, 2006 PDF

Pay attention to CMS clarification

Myth: You can have a nurse practitioner (NP) or physician assistant (PA) come in and start a consult. The NP or PA can do the work-up and ask the patient some questions, and then the doctor can come in afterward and review their work. You can bill this as a consultation.

Reality: Medicare doesn't allow you to bill consults as -shared visits,- says consultant Maggie Mac with Pershing Yoakley & Associates in Clearwater, FL. When a doctor asks for a consult, he or she is only seeking your physician's opinion, not that of other providers in your  office.

The Centers for Medicare & Medicaid Services clarified that you can't bill a shared consult last year. (See PBI, Vol. 6, No. 17.) But many providers still do not realize that Medicare doesn't allow this practice, says Mac.

Also, many providers believe you can bill a shared visit in the physician office setting, instead of the hospital. But since shared visits in the physician office must follow the -incident-to- billing rules, there's no point in billing an office shared visit, says Mac.