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Thread: NP- how to determine when they bill a new visit?

  1. #1

    Smile NP- how to determine when they bill a new visit?

    AAPC: Back to School
    One of our NP's is wanting to bill a new patient visit. We are billing under the pediatrician she is collaberated with. The patient has been seen by another peditrician of ours in the past 3 years. Can we bill a new visit?
    How do we know when we can bill for a new patient E&M with a NP? Do you go by if they have seen another NP in our group in the past 3 years of if they have seen another physician of ours in the past 3 years?

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    If they all bill under the same tax ID and are part of the same group, they should be considered as the same "provider" (NP or doctor).

    This patient would be new to the NP, but probably billed as established.

  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    If they have been seen by any provider in your practice of the same specialty within the last 3 years they are an estb patient. You cannot bill new patients nor new problem encounters under the physician for an NP encounter. In order to bill the visit under the physician the incident to parameters must be met. You need to assume that every carrier follows the CMS policy regarding incident to billing unless you have a written policy from the carrier that states differently. If the carrier does not credential the NP this is not an indication to bill under the physician.

    Debra A. Mitchell, MSPH, CPC-H

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