How to bill an E/M for a NP without provider being present?

yahairag2@aol.com

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I have a provider who sometimes is not present during an office visit. He signs off on the notes as agreeing to the assessment plan the NP wrote. Do I still bill this visit as a regular visit, (ex: 99214,93010) or should I bill a different way (ex: using a modifier)?
 

thomas7331

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The CPT codes you assign will not change, but if the supervising MD is not in the office at the time of the encounter, then the claim needs to be billed under the credentials of the NP, not the MD, because the 'incident to' requirements have not been met. Some commercial payers may have some specific rules for NP billing, such as requiring the SA modifier, but unless your payer has this policy, there is no specific modifier you need to add.
 

yahairag2@aol.com

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The CPT codes you assign will not change, but if the supervising MD is not in the office at the time of the encounter, then the claim needs to be billed under the credentials of the NP, not the MD, because the 'incident to' requirements have not been met. Some commercial payers may have some specific rules for NP billing, such as requiring the SA modifier, but unless your payer has this policy, there is no specific modifier you need to add.
I forgot to mentioned, the practice is in a facility. The NP gets paid by the facility.
I'm assuming because the NP gets paid by the facility, we cannot bill under the NP's credentials.
 

thomas7331

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I forgot to mentioned, the practice is in a facility. The NP gets paid by the facility.
I'm assuming because the NP gets paid by the facility, we cannot bill under the NP's credentials.
If the NP is employed by the facility, then it must be billed under the NP's credentials - there's no other way to do it. It's the facility that needs to bill for the NP, which would be done with the NP's credentials and under the facility's tax ID number - the facility should have the NP credentialed to bill this way. 'Incident to' never applies in a facility, so no claims should ever be billed under the MD if the services are taking place in a hospital.
 

yahairag2@aol.com

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If the NP is employed by the facility, then it must be billed under the NP's credentials - there's no other way to do it. It's the facility that needs to bill for the NP, which would be done with the NP's credentials and under the facility's tax ID number - the facility should have the NP credentialed to bill this way. 'Incident to' never applies in a facility, so no claims should ever be billed under the MD if the services are taking place in a hospital.
Thanks
 
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