Wiki NPP and PA Billing Guidance Needed

[PLDalsoren]

Hello! I have several questions regarding proper billing procedures in the hospital for NP's and PA's. These are professional charges. I'm a relatively new coder and have just been given a list of questions on billing procedures and this is kind of overwhelming. Is there a seasoned coder who would be willing to answer my questions? I would be happy to connect over the phone or email.

Thank you!
Patti Dalsoren

 

[csperoni]

It might help if you post the questions, or at least what the questions are in reference to. Is it regarding split/shared? If so, there are already several helpful posts on this topic.

 

[PLDalsoren]

It might help if you post the questions, or at least what the questions are in reference to. Is it regarding split/shared? If so, there are already several helpful posts on this topic.

The doctors are asking the following questions:
1) Both the doctor and the NPP are scrubbed in and performing insertion of a non-tunneled centrally inserted central venous catheter (36556). If both are scrubbed in, who's NPI is the charge billed under? Is there a rule to decide who "performed" the service and how should that be documented in the record?
2) Let's say the same procedure is being performed but this time the NPP is performing the procedure but the physician is standing next to them supervising the entire time (not in a teaching physician capacity). The doctor wants to know if the procedure can be billed under him because he was right there the whole time. (I told them no, it has to be billed under the provider who performed the service)
3) Once again, same procedure but this time the doctor performs the procedure. Can the NPP's write the note and the doctor attest to its accuracy and sign it? (It appears that Medicare allows NPP's to function in the capacity of a scribe as long as they have no part in the procedure)
4) If a PA is performing a procedure (36556 for example) and the charge is being billed under the PA, what are the supervision requirements for the doctor? Do they have to be in the room, in the hospital? This is in the state of Wisconsin.
Please note, I have done my research and am doing my best to figure this out. However, I have 8 doctors who don't believe me so I'm looking for confirmation that the information I have put together is correct and accurate. Thank you!

 

[jkyles]

1. Whether they both scrubbed doesn't determine who is paid. The documentation should indicate who performed the procedure and it should be billed accordingly. Assistant, co-surgeons and team surgeons aren't allowed for this service.
2. The NPP. There's no "I watched" provision for payment.
3. Yes, NPPs can act as scribes but they can't participate in the service and they can't add anything to the note even if the MD forgets something.
4. There's no supervision requirement for this service according to the Medicare physician fee schedule. You'll need to check your state's scope of practice for NPs and PAs to see if there are any additional requirements.

 

[PLDalsoren]

1. Whether they both scrubbed doesn't determine who is paid. The documentation should indicate who performed the procedure and it should be billed accordingly. Assistant, co-surgeons and team surgeons aren't allowed for this service.
2. The NPP. There's no "I watched" provision for payment.
3. Yes, NPPs can act as scribes but they can't participate in the service and they can't add anything to the note even if the MD forgets something.
4. There's no supervision requirement for this service according to the Medicare physician fee schedule. You'll need to check your state's scope of practice for NPs and PAs to see if there are any additional requirements.

Thank you so so much! I greatly appreciate you taking the time to answer all of these questions! It's extremely helpful.