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Thread: Medicare NPP/Consults Rules

  1. #1

    Default Medicare NPP/Consults Rules

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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. #3


    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
    Join Date
    Apr 2007


    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. #5


    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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