Wiki NP billing consults sent from supervisor ?

[cpccoder2008]

We do the billing for physician's at a hospital. We have a wound care NP who wants to bill Consults for patients that are sent to her from surgery. She was told she cannot bill consults because the reffering physician's is her supervisor and she falls under the surgery specialty. She has her own number and does her own billing. I came across this while reading the coding edge and wanted a little more feedback on it. Can someone tell me if this would apply to our situation and that she can indeed bill consults ? Thanks

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.10 - Consultation Services (Codes 99241 - 99255)

E. Consultations Requested by Members of Same Group

Carriers pay for a consultation if one physician or qualified NPP in a group practice requests a consultation from another physician in the same group practice when the consulting physician or qualified NPP has expertise in a specific medical area beyond the requesting professional's knowledge. A consultation service shall not be reported on every patient as a routine practice between physicians and qualified NPPs within a group practice setting.

 

[mitchellde]

No the NP may not bill a consult in your scenario because the NP is in the same specialty as the supervising physician.. In the paragraph you cite it states the consulting physician or NP has expertise in a specific medical area beyond the requesting physician. From what you say it sounds as if the physicina is referring the patient to the NP for continued wound care. There for the three Rs are not met it is not a consult.