Results 1 to 8 of 8

Nurse practitioner billing question

  1. #1
    Default Nurse practitioner billing question
    Medical Coding Books
    Can a nurse practitioner do joint injections? Assuming they can, if the NP and MD go into a room together and the NP does the injection and the MD does the E?M, whose name goes on the documentation? And does this get billed under the MD or the NP? Any help would be greatly appreciated as I am not the familiar with the guidelines for NPs.

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    If the answer is "yes" to the qualifications below...then Yes they can perform the service:

    The services of an NP may be covered under Part B if all of the following conditions are met:
    • They are the type that are considered physician’s services if furnished by a doctor of medicine or osteopathy (MD/DO);
    • They are performed by a person who meets the definition of an NP (see subsection A);
    • The NP is legally authorized to perform the services in the State in which they are performed;
    • They are performed in collaboration with an MD/DO (see subsection D); and
    • They are not otherwise precluded from coverage because of one of the statutory exclusions. (See subsection C.2.) 2. Incident To If covered NP services are furnished, services and supplies furnished incident to the services of the NP may also be covered if they would have been covered when furnished incident to the services of an MD/DO as described in §60.

    http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf
    (Section 200)

    As for who receives credit...

    If the physician performs the E/M, I would credit the physician; even though the NP is peforming the injection. It almost sounds as if the MD is utilizing the NP in a nursing capacity. My opinion...not a cost effective way to use a NP.

  3. #3
    Default higher reimbursement
    I guess I'm just leary of crediting the physician because I don't want it to look like I'm billing under the physician for the higher reimbursement.

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    I completely understand.

    In the event that "incident to" doesn't apply...bill under the NP and his/her NPI #. Again, in this scenario, it appears that the NP was used in a nursing capacity. Anyone else?

    http://www.medscape.com/viewarticle/408391_5

  5. #5
    Default
    If this is a Medicare patient....your NP should be seperately enrolled and should be credited themselves...of course if they meet the criteria above...and it's within their scope of practice defined by the physician and approved by your state.

    If there was an E/M performed which was seperately identifiable then you should code out the E/M w/ modifier 25 and the joint injection CPT for the NP....

    If this is a private insurer, you'd have to bill under the physicians name for it all...

    I do agree it isn't very cost effective to perform services this way. My opinion is it needs to be one way or the other....

    too many "Ifs"...
    Last edited by ARCPC9491; 03-31-2009 at 09:18 AM.

  6. #6
    Default
    So if the NP can be seperately credentialed, the E/M should be under the MD and the injection should be under the NP...

    I don't really agree this is a cost effective way either but I don't have a lot of say in that

  7. Default
    Is there more information as to why the MD/NP performed the service together? For instance, was this a new patient or new problem for established patient? Is the NP new to the practice? Did the NP really perform the E&M and needed the MD's opinion so the MD went in after and re-performed?

    Is there separate documentation for the 2 services? If the documentation clearly shows that the MD performed the E&M service and the NP performed the "nursing" service, then I would not be worried about ramifications of billing under the MD because the documentation supports it.

    Amy

  8. #8
    Default
    The MD saw the pt first, then went back in to do the injection and the NP went with him. I think the MD was observing her to make sure everything went okay. The NP has never done the joint injections at this practice, but the NP did not provide any evaluation or management. There is seperate documentation for both. My supervisor thinks that we can bill under the MD since he performed the E/M and oversaw the injection, but it was under Ohio Workers Comp, so our NP has her own credentials with them so I didn't know if the claim should be split.


    Quote Originally Posted by donsqueen View Post
    Is there more information as to why the MD/NP performed the service together? For instance, was this a new patient or new problem for established patient? Is the NP new to the practice? Did the NP really perform the E&M and needed the MD's opinion so the MD went in after and re-performed?

    Is there separate documentation for the 2 services? If the documentation clearly shows that the MD performed the E&M service and the NP performed the "nursing" service, then I would not be worried about ramifications of billing under the MD because the documentation supports it.

    Amy

Similar Threads

  1. Nurse practitioner billing
    By ecaissie in forum Modifiers
    Replies: 4
    Last Post: 05-29-2014, 10:00 PM
  2. Nurse Practitioner Billing - I have a doc who is a PhD
    By bill2doc in forum Internal Medicine
    Replies: 7
    Last Post: 10-12-2012, 10:25 AM
  3. Nurse Practitioner Billing help??
    By JLuz in forum Billing/Reimbursement
    Replies: 2
    Last Post: 08-30-2012, 11:06 AM
  4. Question?? Medicare & billing for nurse practitioner
    By jschultz3 in forum Medicare Regulations
    Replies: 3
    Last Post: 08-10-2011, 12:19 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.