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Anjetta Posted Sun 02nd of July, 2017 23:12:14 PM
I work at a VA and we follow medical guidelines. Recently, productivity has become a issue at our facility. Our medical director does not see patients and to show her participation in interdisciplinary care meetings - the productivity was changed to give her credit for these meetings. First the NP see's the patient and develops the care plan as this program has no nurses- (the program eliminated RN's and the used to do the careplan until the program went to NP model). The code used is S0250. because the meetings are not the 30 minutes to code 99368 which is what we were told to use until I questioned that we do spend meet the minimum of 30 minutes per guideline. The chief of the coding department states since she is the primary/medical director we need to give her the credit because she is ultimately responsible for all the patients. To date she has not seen one patient. We are a home based primary care program and all patient's are seen in the home. Again she has not made one home visit and her contribution to the IDT meeting is primarily her presence. She writes a note at the end of the meeting and states she agrees to are plan of care - occasionally she make a simple recommendation such as draw a vitamin d level at next visit. But no significant contribution to care plan. I find this unethical- since again she does not make a significant contribution to the care plan nor does she have any interest is doing a face to face visit with the NP's. I use the code s028l maintaining a careplan as not all patient's are not all geriatric patients; but all the other NP's use S0250. what would be appropriate in this situations if the directive is to give the medical director credit.
SuperCoder Answered Mon 03rd of July, 2017 07:52:18 AM

As per Medicare guidelines; For NPP services outside the office setting, e.g., in a patient’s home or in an institution (other than hospital or SNF), the NPP.s services are covered incident to a physician’s service only if there is direct supervision by the physician. For example, if an NPP accompanies the physician on a house call and evaluates a patient, the NPP.s services are covered. incident to. This means the service can be reported using the supervising physician’s national provider identification number (NPI). This service will be paid as if the physician personally performed the service.

 

If the NPP made the house call alone, the services are not billable. incident to. the physician. In this situation, the service must be reported using the NPP.s NPI. The service may not be reported with a physician’s NPI because the physician is not providing direct supervision.

 

HCPCS code S0250 indicates “comprehensive geriatric assessment and treatment planning performed by assessment team”, i.e., it must be performed by a multi-disciplinary team of experts; however, in your scenario, only 1 NP performed the service.

 

So, you can bill S0281 for the service performed.

 

 

 

Note: “S” code services are not payable by Medicare. Kindly check with your respective insurance payer for reimbursement of S codes.

 

Follow the link for more clarity.

http://www.in-afp.org/clientuploads/CodingBillingPDFs/Incident_to_Services_8_1_07.pdf

Anjetta Posted Fri 07th of July, 2017 13:39:37 PM
The meeting does consist of a multiple disciplinary team which includes the social worker, dietician, Medical director, OT, NP and the pharmacist. Everyone sees the patient for a face to face visit except the medical director- and text credit for the meeting with the so250- so the question is not related to incident to billable for the physician- but can the NP take credit for the IDT meeting since the NP sees the patient - writes the plan of care . Again the medical director does not see patients - but participates mainly listening and may augment by a suggestion to the NP care plan
SuperCoder Answered Mon 10th of July, 2017 07:43:32 AM

As per the presented documentation, the multidisciplinary team saw the patient, hence, the appropriate code for treatment planning performed by assessment team would be S0250.

Also, it won’t be wrong on the part of the physician to bill for the service, as the physician also participated (listening and augment by a suggestion to the NP care plan) in the treatment plan.

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