Wiki 2 visits by 2 different NPPs same day. How to bill?


Papillion, NE
Best answers
We are a multi specialty group. If our cardiology NPP sees the patient and then is sent over to see the internal medicine NPP same day how is this billed? (This is for a Medicare patient and the NPP is not billing incident to the physician). If they have both listed "time" in their documentation, can we add both times together and bill under one of the NPP's?
If you are billing these properly (with supervising physician information), BOTH of these visits are billable and payable.
Effective March 1, 2022, E/M services submitted by NPs (Specialty 50) and PAs (Specialty 97) can be considered for coverage when another E/M service from a multispecialty group has been provided.
  • More than one E/M service by PA or NP payable on the same day
    CMS allows one E/M service per beneficiary, per day, per provider specialty type. Since PAs and NPs often provide specialty care (e.g., family practice, psychiatry, orthopedics), multiple E/M services on the same DOS may be permissible, when each episode of care is addressing a different clinical condition. The additional E/M service would need to be medically necessary to treat an illness or injury separate from the initial E/M service. A different diagnosis would be required.
  • Changes in processing NP and PA claims for E/M services
    As of March 1, 2022, NP and PA providers will need to include additional information on each E/M claim, defining the specialty of the physician group when care is rendered in a specialty practice environment. Claims will be suspended to review specialty information and compare diagnosis codes. When both the specialty information and diagnoses are different, the second claim may be payable.
  • How do NP and PA providers include specialty information on their claims?
    When a service is rendered by a NP (Specialty 50) or PA (Specialty 97) in multi-specialty group, the subspecialty information must be included in the 2400 NTE Segment Loop on electronic claims or Box 19 of the CMS 1500 form (example: 06-cardiology). If the subspecialty information is missing on either the current or history claim, the subsequent E/M service may deny. Specialty codes and their definition that can be found on our website at Eligible Specialties.
    • Note: If practicing as an NPP in a multi-specialty group, add specialty 50 or 97 in the 2400 NTE Segment Loop on electronic claims or Box 19 of the CMS 1500 form to avoid future denials of new patient services performed under a sub-specialty.