Wiki NP/PA question

[mmagness]

If both a physician and an NP/PA see a "new patient" or "consult" a Medicare patient (together on the same visit/day) is it appropriate to bill under the Physician's NPI #? This could not be billed incident to because Medicare states that you can't bill "incident to" for patient's with a new problem. Since the physician was involved he should get credit right?

Since the doctor is establishing the care and diagnosing the patient is it okay to bill under the NPI of the physician even though the NP/PA was involved? Would the physician or PA (whoever dictates) just need to document the doctor's envolvement and to what extent?

Thanks,

MollyM

 

[mcpalmeter]

NP/PA Question

Hi Molly,

Wow! I think there are several questions to answer in your post.

1) If the NP/PA is acting as a scribe and specifiy acts in this capacity and documents that he/she is acting only as a scribe and is documenting everything done by the physician and the physician is doing everything that supports the service billed, then that is not shared billing or incident to. In this case it is a physician service since the physician is doing all of the work.

2) Keep in mind that there is no shared billing for consultations and that shared billing is not applicable in an office setting.

3) New patient visits cannot be billed incident to the physician. Therefore, in order to bill under the physician's provider number the physician must do all of the work that supports the code billed.

4) Consults can be performed on new or established patients. In order to bill for NPPs under the incident to provision, the service must be an integral, although incidental, part of the physician's personal professional services, and they must be performed under the physician's direct supervision. It does not appear from your question that the service being provided by the NPP is incidental but rather an instrumental part of the service.

5) Keep in mind that the ROS and PFSH (but not the HPI) can be provided by anyone and as long as the physician documents where that information can be located and that he/she has reviewed the information and updated/revised it as appropriate.

I hope this helps.

Maryann Palmeter, CPC, CENTC