Question Billing for Nurse Practitioner in Urgent Care

Worxs43

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Hello,

Any answers/advice would be greatly greatly appreciated. Currently coding for urgent care where the providers that handle the patients are nurse practitioners. At this time I have been billing the services performed such as lacerations, cerumen irrigation, etc.., adding the appropriate E/M along with adding a supervising physician when msg prompts for me to do so for particular insurances. The problem came about a couple days ago when talking to a co-worker who stated she only codes for the E/M she does not code for the procedures and did not state why not. From what I researched NP's can perform laceration repairs, suture removals, ear irrigation and splints so I'm confused. Wondering what I may be missing, is it possibly because the supervising physician(s) is not on site, they are at the hospital-3 miles away, is it something that may have been an error on her part, or is it something totally different from what I'm thinking?

Again any advice greatly appreciated.



Worried,

Worxs43
 

thomas7331

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I do not know why your co-worker would not code the procedures that are being performed - I can't think of any reason why you would only code an E&M and omit procedures for any provider, NP or otherwise, unless perhaps your clinic falls under a particular type of facility that has specific payer billing requirements. Regarding the supervising physician - if they are not on site, you will not want to bill the services as 'incident to', but just 'adding a supervising physician when msg prompts' does not indicate how exactly that claim is going out from your billing system - this may or may not be the correct process for your facility.

If you and your co-worker are coding these service as radically differently as you describe, this is something you need to take to a supervisor or manager. I don't think you can get an accurate answer here on the forum - someone who is familiar with and knowledgeable about your coding and billing software, internal processes, and your facility's status as related to the hospital needs to review this for you and make sure that everyone is understanding correctly what needs to be done to ensure accurate claims are being submitted.
 

Worxs43

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Thomas7331,

Thank you for your help. Honestly I've been searching all over the web which I found another answer to this similar question from a few years back within this forum pretty much saying bill the E/M with the procedure adding a modifier 25 or 57 or simply just bill for the procedure or for just the E/M of course depending on the documentation etc... but everyone is stating in some form to add the procedures so again I'm a little lost regarding my co-workers response.

Yes I will definitely talk to my supervisor to see how the coding should be handled. Honestly I don't know of anything special with the setup that would cause for me to just code for E/M....just odd to me.


Again thank you for your advice,

Worxs43
 
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