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Medicare NPP/Consults Rules

  1. Default Medicare NPP/Consults Rules
    Medical Coding Books
    Did anyone read this months new issue of the Coder's Edge? Apparently it is stating as a fact that NPP's such as PA's cannot do InPatient Consults per Medicare? I know consults cannot be shared; and that usually in the inpatient setting it is always a new problem for the consultation, in the hospital setting, medicare was going to allow that PA's be able to do the consult; and, the MD that the PA is working for is not with the PA, but, is in a phone call away reach, another Inpatient problem that Medicare was working with I thought?

    What do you know about all this. I think it is an error printed in the magazine.

    Kathleen Wolfe
    Digestive Health Associates of Southwest MI, PC

  2. #2
    North Carolina
    I haven't read it yet but it must be an error. Did they have a supporting reference?

    "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."


  3. Default
    Just another note about our PA. He is qualified too since he has been working with our GI specialist since 2003 in the hospital setting.

    Thanks again.

  4. #4
    I didn't see that in the article. It does state there is no incident to on the inpatient side.

    "Medicare clarifies that incident-to services cannot be rendered
    by an NP or PA on a patient's first visit. Incident-to services
    cannot be billed for services rendered to hospital patients or
    to patients in a skilled nursing facility (SNF) who are in a
    Medicare-covered stay."

    Which is correct, so if you were billing inpatient consults done by the PA under the doctor it would be incorrect.

    Laura, CPC, CEMC

  5. Default
    We are not billing it incident to so we are doing it right. OK, that is confusing, but I appreciate your help! Mucho gracious!

    Kathleen W.

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