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Modifier for Nurse Practitioner for E&M Services

Leorah Posted Sun 27th of January, 2019 16:51:44 PM
Our nurse practitioner meets with patients in the hospital and provides evaluation and management services. These are non procedure appointments where we would generally code an Evaluation and Management Code. Which modifier should we be using when submitting claims for service she rendered?
SuperCoder Answered Mon 28th of January, 2019 04:24:10 AM

Hi Leorah,

The modifier that the nurse practitioner should use while performing E/M services in hospital setting will be SA. However, you may check with payer policy to find out their modifier SA payment policies. For example some payers use modifier SA just informational to indicate that  physician submitted claims involving NPPs and some like Cigna’s policy states that modifier SA will pay "85 percent of fee schedule or maximum reimbursable rate. To get more clarity on this modifier please follow the link provided below. Feel free to ask for any further query.

https://www.supercoder.com/coding-newsletters/my-evaluation-management-coding-alert/modifiers-uhc-now-mandates-appending-modifier-sa-on-npp-em-claims-156034-article

 

 

 

 

Leorah Posted Tue 02nd of July, 2019 09:06:18 AM
Is there a place on the claim such as a specific box where we need to enter the information on the supervising provider for a mid level practitioner? Do we have to make sure all NPPs notes are cosigned? When there is a follow up evaluation are we are allowed to bill with just the NPP name and without a co-signature on HCFA claim?
SuperCoder Answered Wed 03rd of July, 2019 10:17:07 AM

Hi Leorah,

The regulations for having physicians cosign notes varies by state. You'll need to check the nonphysician practitioner (NPP) rules in your state, as those will govern when you need the physician's signature.

This is not a CMS or payer requirement, but rather a state regulation.

NOTE:  Effective April 1, 1999, HCFA will no longer require the use of modifiers for submitting a claim for a NP service with the exception of the AS modifier for reporting an Assistant at Surgery service.

 

 

Leorah Posted Sun 07th of July, 2019 05:35:51 AM
Where on the claim would we indicate the supervising provider. Is there a box that needs to be filled out?
SuperCoder Answered Mon 08th of July, 2019 09:48:45 AM

Check with the box number 33 of the HCFA form, there we need to indicate supervising provider. You may also check with box 31, where signatures of supervising provider is required. Feel free to ask for any further query.

Leorah Posted Mon 22nd of July, 2019 09:19:41 AM
When I did a bit more research with my EHR system, they indicated we need to add the supervising provider in box # 17 with a DQ. Please see the attached reference https://www.medicalbillingstudycourse.com/updates/qualifiers-needed-for-referring-ordering-and-supervising-providers/
SuperCoder Answered Tue 23rd of July, 2019 08:33:13 AM

Hi Leorah,

Seeing the above link, it shows, to fill column 17 is mandate. However, if nurse practitioner independently sees patient for the visit she has to bill for, she just needs to fill NPI of provider. That is she needs to fill 17b, which is mandate. You may check the below link for more clarity. She may fill the provider name from the previous visits or the first visit (new patient visit) of that patient with that doctor.

https://medicare.fcso.com/education_resources/0299044.pdf 

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