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Nurse Practitioner Consultations

  1. #1
    Default Nurse Practitioner Consultations
    Medical Coding Books
    Question: If there is a Nurse Practitioner from Pulmonary who does a consultation on an inpatient and also a Nurse Practitioner from Neurology that does a consultation on the same inpatient on the same day and both specialties bill under the same tax ID, are both consultations reimbursable by Medicare? Any input appreciated.
    Neurosurg

  2. #2
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    North Carolina
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    Quote Originally Posted by mbabou View Post
    Question: If there is a Nurse Practitioner from Pulmonary who does a consultation on an inpatient and also a Nurse Practitioner from Neurology that does a consultation on the same inpatient on the same day and both specialties bill under the same tax ID, are both consultations reimbursable by Medicare? Any input appreciated.
    Keep in mind that MCR no longer recognizes consultations; therefore, you would report the appropriate E/M code based on POS. For inpatient, each provider would report 99221-99223 since they are of different specialties; assuming that the laws for your state permit NPP to bill for these services.

    MCR Chpt 12:

    "Medicare will pay for E/M services for specific non-physician practitioners (i.e., nurse practitioner (NP), clinical nurse specialist (CNS) and certified nurse midwife (CNM) whose Medicare benefit permits them to bill these services. A physician assistant (PA) may also provide a physician service, however, the physician collaboration and general supervision rules as well as all billing rules apply to all the above non-physician practitioners. The service provided must be medically necessary and the service must be within the scope of practice for a non-physician practitioner in the State in which he/she practices."

    "Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group."

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