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Share/Split--NP's and PA's

  1. Default Share/Split--NP's and PA's
    Medical Coding Books
    If a NP/PA performed the initial visit, what must the MD notate for him to receive reimbursement? Can he write "agree with above"? NP/PA does not have their own UPIN. It will be billed under the physician. Thank you,

  2. #2
    I'm not sure who the insurance is you are billing but if it is Medicare, the doctor must actually see the patient initially before any incident to services are covered.

    This is from CMS

    "A nonphysician practitioner such as a physician assistant or a nurse practitioner may be licensed under State law to perform a specific medical procedure and may be able (see §§190 or 200, respectively) to perform the procedure without physician supervision and have the service separately covered and paid for by Medicare as a physician assistant's or nurse practitioner's service. However, in order to have that same service covered as incident to the services of a physician, it must be performed under the direct supervision of the physician as an integral part of the physician's personal in-office service. As explained in §60.1, this does not mean that each occasion of an incidental service performed by a nonphysician practitioner must always be the occasion of a service actually rendered by the physician. It does mean that there must have been a direct, personal, professional service furnished by the physician to initiate the course of treatment of which the service being performed by the nonphysician practitioner is an incidental part, and there must be subsequent services by the physician of a frequency that reflects the physician's continuing active participation in and management of the course of treatment. In addition, the physician must be physically present in the same office suite and be immediately available to render assistance if that becomes necessary."

    Laura, CPC

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