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NPP and consultation help

  1. #1
    Default NPP and consultation help
    Medical Coding Books
    A consultation can not be a split/shared visit, but our physicians want to use our PA's for on call at the hospital. We are having alot of debate as to whether the PA's can perform any part of the consultation. Can a PA do any part of the consultation;like taking the HPI or the ROS, then the physician come in and do the exam and MDM? Then the pt would act as the scribe, making it clear the physician did the exam and MDM. Just wondering what others think and are doing. Thanks.

  2. #2
    North Carolina
    "Incident to" does not apply in the hospital setting.

    In the hospital setting, the consulting physician or qualified NPP shall use the appropriate Initial Inpatient Consultation codes (99251 – 99255) for the initial consultation service.

    In the office or other outpatient setting, the consulting physician or qualified NPP shall use the appropriate Office or Other Outpatient Consultation (new or established patient) codes (99241 – 99245) for the initial consultation service.


    When a qualified nonphysician practitioner (NPP) and a physician each provide a portion of the consultation services, the split/shared services may not be billed as a consultation, according to the Medicare Claims Processing Manual. If an NPP provides the bulk of the service, the NPP should report the appropriate code under his or her own provider number even if the physician documents examining the patient and reviewing the management plan.
    Last edited by RebeccaWoodward*; 01-21-2009 at 02:47 PM.
    Rebecca CPC, CPMA, CEMC

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