Wiki Help ASAP

[NESmith]

If an ARNP who works in an office with the provider who is going to perform a procedure and the ARNP see the patient for an E/M and bills under her number does she still have to append Modifier 25 to her visit or is this only if she bills "incident to" the provider?

Thanks so much always for your help.

 

[FTessaBartels]

Nothing to do with incident to

If I understand the scenario correctly, this service has nothing to do with "incident to."

You state that the provider who is going to perform a procedure . This indicates to me that the reason for the visit is the procedure. The reimbursement for the procedure includes the pre- and post-operative evaluation/management necessary for that procedure. So it cannot be billed whether performed by the physician him/herself or by the PA or NP working in that same office.

For example, patient scheduled for colonoscopy. NP does the pre-procedural E/M before gastroenterologist performs procedure. NO separately billable E/M.

On the other hand. Patient scheduled for lesion removal on right forearm. However, patient arrives with complaint of rash on chest. NP evaluates and treats for rash. This is a significant and completely separately identifiable E/M performed on the same day as the procedure. You would code the E/M (under the NPs name/number) with a -25 modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC