Wiki Two NP's Billed with E/M Codes???

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Mariefonseca

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I need some advice on how to bill for these claims..
Two different NP's saw the same individual on the same day. One for Internal Medicine and the other Psychiatry. Both NP's submitted billing using E/M code 99213 and Psychiatry 99214. According to MCR, they will only pay one E/M since the services were rendered by NP's. Is this true? if not, how do you bill for these two separate procedures?

Thank You :confused:
 
Here is what WPS MAC for J5 and J8 has said but you may want to check with your MAC if different.
Mid Level providers and Appropriate Billing
Question: Our MD/DO saw the patient 2 years ago. The patient is now coming for services by the physician assistant (PA.) Is it appropriate to bill these evaluation and management services (E/M) as a new patient or should I submit the services as a subsequent patient. The services are not part of the plan of care from two years ago.

Answer: Medicare rules state that a patient is considered new when there has been no face-to-face encounter with the same physician or a member of the same group with the same specialty in the previous three years. You can bill the service as a new patient under the PA provider number as long as no other PA in your group has billed an initial visit. The MD/DO and mid level provider are different specialties. Medicare enrolls a mid level based on their designation, such as physician assistant (97), rather than the clinical area to which they have specialized.
 
NPs are not specialists

Hi,
From my understanding, being an NP is it's own "specialty" so the fact that the NPs are located in 2 different specialty practices doesn't help. If the pt saw an MD and NP, both would be payable but not when a patient sees 2 NPs on the same day.
 
Billing/Collections Rep

I hope this helps & it makes no difference is both providers are NPs, as long as they are certified.

Encounters with more than one health professional and multiple encounters with the same health professionals which take place on the same day and at a single location constitute a single visit, except when one of the following conditions exist: (a) after the first encounter, the patient suffers illness or injury requiring additional diagnosis or treatment; (b) the patient has a medical visit and a clinical psychologist or clinical social worker visit.
 
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