Wiki BILLING U/S UNDER DOCTOR FOR READING IT vs BILLING UNDER NP WHO PHYSICALLY SEEN PT??

[centralizedcoding]

I have a doctor that has asked me if when a patient comes in to see our NP(s) and also has an u/s at that visit if those could be billed under the doctor since they are the ones reading/interpreting these reports.

Informational stuff that might help you understand a little more:
-Our NP(s) are credentialed w/ the majority of payers therefore we bill under them when they perform the visits_(E/M & U/S or U/S when provided for routine OB care)
-The practice does employ our own sonographer's that utilize the machines that the practice has also acquired

My understanding from things that I have researched into is that if the u/s is performed in our office by staff employed by the practice, we'd be providing both technical and professional components of the service so utilizing a modifier on the ultrasound CPT billing it under the provider and then billing the E/M under the NP wouldn't be appropriate (this is geared towards GYN only visits). Now on the other hand, OB/Global maternity care I can see making more sense doing it this way. Reasoning: Routine OB care is posted under 99499 $0 charge under DR or NP whichever seen pt on that DOS and once delivered the global is billed under the doctor of record, the doctors sign off on every NP prenatal note and also sign off on the printed/scanned u/s document.

Is anyone else familiar with this? Am I missing something or maybe just not understanding something? I'm just looking for guidance or anything that could point me in the right direction of something more specific I need to be looking into. TIA!

 

[nielynco]

I have a doctor that has asked me if when a patient comes in to see our NP(s) and also has an u/s at that visit if those could be billed under the doctor since they are the ones reading/interpreting these reports.

Informational stuff that might help you understand a little more:
-Our NP(s) are credentialed w/ the majority of payers therefore we bill under them when they perform the visits_(E/M & U/S or U/S when provided for routine OB care)
-The practice does employ our own sonographer's that utilize the machines that the practice has also acquired

My understanding from things that I have researched into is that if the u/s is performed in our office by staff employed by the practice, we'd be providing both technical and professional components of the service so utilizing a modifier on the ultrasound CPT billing it under the provider and then billing the E/M under the NP wouldn't be appropriate (this is geared towards GYN only visits). Now on the other hand, OB/Global maternity care I can see making more sense doing it this way. Reasoning: Routine OB care is posted under 99499 $0 charge under DR or NP whichever seen pt on that DOS and once delivered the global is billed under the doctor of record, the doctors sign off on every NP prenatal note and also sign off on the printed/scanned u/s document.

Is anyone else familiar with this? Am I missing something or maybe just not understanding something? I'm just looking for guidance or anything that could point me in the right direction of something more specific I need to be looking into. TIA!

I am not sure why this is an issue. If the NP is the one who is doing the official interpretation of the ultrasound and is credentialed with the payer to do so and bill for it (and as you are using the office equipment), you bill for the ultrasound with no modifier under the billing # for the NP. The same would apply to an OB ultrasound. It does not matter if you require that the MD sign off on the interpretation - you only get paid for the approved initial interpreter to bill for it. Whether or not you can bill an E/M depends on the reason for it. It is was a separate significant service (ie, she is not presenting for the ultrasound, but rather a problem and then an ultrasound is ordered to evaluate it) then bill for both (except OB which is global). You should not, however, need a modifier -25 on the E/M at the same time as the U/S as it is a diagnostic test rather than a surgery.

 

[tloeb]

I have a doctor that has asked me if when a patient comes in to see our NP(s) and also has an u/s at that visit if those could be billed under the doctor since they are the ones reading/interpreting these reports.

Informational stuff that might help you understand a little more:
-Our NP(s) are credentialed w/ the majority of payers therefore we bill under them when they perform the visits_(E/M & U/S or U/S when provided for routine OB care)
-The practice does employ our own sonographer's that utilize the machines that the practice has also acquired

My understanding from things that I have researched into is that if the u/s is performed in our office by staff employed by the practice, we'd be providing both technical and professional components of the service so utilizing a modifier on the ultrasound CPT billing it under the provider and then billing the E/M under the NP wouldn't be appropriate (this is geared towards GYN only visits). Now on the other hand, OB/Global maternity care I can see making more sense doing it this way. Reasoning: Routine OB care is posted under 99499 $0 charge under DR or NP whichever seen pt on that DOS and once delivered the global is billed under the doctor of record, the doctors sign off on every NP prenatal note and also sign off on the printed/scanned u/s document.

Is anyone else familiar with this? Am I missing something or maybe just not understanding something? I'm just looking for guidance or anything that could point me in the right direction of something more specific I need to be looking into. TIA!

So is it the NP or the Doctor that is reading/interpreting the reports? If it's the NP the NP should bill, if it's the doctor the doctor should bill does not matter who is billing for the visit (whether it be a billable E/M if outside of global or a global no charge OB) the u/s and the visit can be different providers in the same office.