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E/M with an ARNP

  1. Question E/M with an ARNP
    Medical Coding Books
    I'm doing the physician coding for trauma surgeons in a hospital. We've recently hired an ARNP. My question is: If the ARNP does an inpatient daily visit and the physican doesn't sign off on the note, can it still be coded?

    From what I know, it is NOT unless the physician signs it. The ARNP was telling me that it is still codeable but it would not get the full reimbursement. Which doesn't make sense because how would the insurance know that the physician didn't sign the note unless there were under an audit or something.

    Can someone please give me some clarity on this.

  2. Smile
    thanks for the info

  3. #3
    Dover Seacoast New Hampshire
    Frist of all, depending on your state, ARNPs can be credentialled by payers, with their own billing numbers, and submit claims under their own name. These payers don't require co-signatures by physicians (although your facility might). And they can provide E&M services and procedures that are within the scope of their practice.

    Typically reimbursement is 15% less for ARNPs (and PAs) than physician fee schedules. No modifier is required for credentialled mid-level services in this case.

    However: Incident-to services are not billable to Medicare in the inpatient setting.

    You also may not bill for services that are bundled into the surgical global days. I see that you code for a trauma surgeon. If your NPP is rounding following a surgery with 10- or 90-day global period, you cannot bill additionally for that.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

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