Practice Management Alert

Question: An NP employed by the hospital wants to do sutures repairs in the ED and believes the ED group may bill for it if they are in attendance during procedure. Is this possible? What about for a PA when the chart is signed by the attending?

Texas Subscriber

Answer: No. There is no mechanism for an attending physician to bill Medicare for a procedure performed by a nurse practitioner (NP) in a facility setting.

Don’t be confused about applying the "shared service" visits concept for an attending supervising a non-physician practitioner (NPP) and after documenting a face-to-face encounter, reporting the service under the attending’s NPI. Remember that concept, as directed by Medicare Carrier transmittal 1780, only applies to E/M services, not to procedures.

Procedures and interpretations performed by the NPP must be billed using the NPP’s NPI number. The shared service rules only apply to E/M services, as stated, and "incident to" does not apply in the ED.

Any physician or NPP authorized to bill Medicare services will be paid by the carrier at the appropriate physician fee schedule amount based on the rendering NPI. The practitioner who substantially performs the procedure is the one under whose name and number the procedure should be billed.