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Pulmonology Coding Alert

READER QUESTION ~ Does Incident-to Apply to Inpatients?

Question: Can a nonphysician practitioner (NPP) report a consultation that she performs on an inpatient?

Pennsylvania Subscriber Answer: Yes, as long as you report the inpatient consult under the NPP's own provider identification number (PIN), which is soon to become her national provider identifier (NPI).

Medicare allows you to report services that the NPP provides in a hospital setting, as long as you don't report the services incident-to. Therefore, if your NPP provides a consult in the hospital and documents the "three R's" of the consultation (request, review, and report back to the requesting physician or proper notation in the shared record), you can report the appropriate consult code (99241-99245 or 99251-99255 based on whether the patient is outpatient or inpatient) under the NPP's PIN.

Caveat: Other insurers may allow you to bill these services as well, either by assigning a provider number to the NPP or by outlining the supervision requirements.

Make sure to check with your payers prior to instituting practices for the NPPs. In addition, always check your state and hospital scope-of-practice guidelines before you bill an NPP's consult services, because state guidelines can vary throughout the country.


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