Wiki Incident to billing for inpatient consults?

[andrearichelleb]

I have a question that I hope someone can give their opinion on:

scenario:

I code for a group of GI specialists and we also have 3 NPs that see the patients for follow up visits here in the office. When a patient is admitted by a hospitalist and a consult is requested for one of our drs to see the patient ( new or establised at time of admission)The NP is doing the initial consult, filling out the forms and bringing it back to the dr for review. The Dr visits the patient in the hospital later in the day and signs the sheet with the words " i have reviewed all information and personally saw the pt on_____date___". There is no actual dictation done by the physician other than this. I receive an encounter form with a level 4 inpatient consult circled under the docs name.

Im confused by this.

I have a resource book that states:

"Consultations in any location and new pt visits in the office cannot be billed incident to even if the physician sees pt after the NP. Service must be billed inder the NPP provider number.There was no documentation by the physician to indicate that he/she saw the patient so the visit is billed under the provider that documented."

Is filling out the sheet and "stamping" the drs name sufficient ? My gut instinct as a coder says this isnt right, but I just keep going back to the fact that the dr is seeing the patient, and signing the name. Would this be questioned by and RAC audit?

Thanks for your thoughts.

 

[pamsbill]

There is no "incident to" in the inpatient setting. In order to be billed under the MD tt would have to be a shared visit which means the physician would have to see the patient face-to-face and document some part of the visit: history, exam, or MDM.

-PJM

 

[Donna T]

I completely agree with pamsbill. This is what my doc puts at the end off all of her inpatient consults that are done by her NP:

I have personally seen this patient, reviewed the history and all the available data, performed the physical exam as documented above and formulated the plan of care. I agree with the above dictated note by my NP.