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Otolaryngology Coding Alert

READER QUESTIONS:

Apply Incident-to Rules to MA Services

Question: Can a certified medical assistant (MA) bill 99211 with or without an otolaryngologist in the office?


Illinois Subscriber


Answer: The otolaryngologist must be in the office because an MA must bill services incident-to, based on Medicare rules. One criterion of Medicare's incident-to billing is that the physician provide direct supervision, which means he must be in the office suite throughout the service.

Some nonphysician practitioners, however, may bill 99211 when the physician is out of the office, such as in surgery. When an ENT is not present, the NPP should bill the service under her national provider identifier (NPI), not under the otolaryngologist-s. Examples of an NPP who qualifies for 99211 reporting under her own number include a nurse practitioner, physician assistant, certified nurse midwife, or clinical nurse specialist. These providers may also bill higher-level E/M services.

Private payers may reimburse for NPPs- services differently. Make sure you review the physician participation agreement for the managed-care companies your practice contracts with, as well as your state's laws.


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