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Coding for Nurse Practitioners

  1. Question Coding for Nurse Practitioners
    Clearnace Sale
    I need some help! We currently have 2 Nurse Practitioners (NP) in our office that see patients. Our Billing Department is trying to figure out how to properly code for the charges that they give us.

    We used to bill "Incident to" with the -SA modifier on all of the charges with the NP as the Billing Provider and the Doctor on duty as the Supervising Provider. However, several of the insurance companies were denying the claims due to the -SA modifier.

    Then, we started billing the claims WITHOUT the -SA modifier on the charges with the NP as the Billing Provider and the Doctor on duty as the Supervising Provider.

    Our concern is that usually once a patient begins seeing one of our NPs, they don't see the actual Doctors anymore. Is this correct or do the patients still need to see the Doctors every six months like they do when we use "Incident to"?

  2. #2
    Columbia, MO
    The whole concept of incident to billing is that the visit is incident to the physician having already examined the patient for the same dx. Billing under the physician is real tricky stuff and under constant review. My answer is always the same, If the physician has no m,aterial participation in the care of the patient for the same problem then bill using the NP number. Others will tell you that is Medicare only and that commercial insurance sees it different. Medicare is used as the gold standard and most every carrier will defer to what Medicare has set up.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Yes I do agree with Debra. We do have some instances where the other insurance tells us to bill under Dr anyways. Some don't actually contract the mid levels but they say to bill under the Dr. check with the carrier for there guidelines
    Herbie W Lorona Jr., CPC, CPC-H

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