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New Patient E&M and Injection two providers

Melissa Posted Thu 02nd of April, 2015 18:36:24 PM

In the Hospital Outpatient setting (22), The physician saw a new patient for evaluation, he then determined that trigger points were needed and the PA performed the procedure. Can both be billed? Since I can't bill "incident to" in POS 22, can I bill separate claims for the two providers?

SuperCoder Answered Fri 03rd of April, 2015 02:51:53 AM

Yes, you can bill both the CPT codes, New Patient office visit (99201-99205) and CPT codes for Trigger point injection (20550-20553) on the same date of service under Physician name. PA has performed The procedure under Physician supervision, that means, physician can bill it with signed off.

Melissa Posted Fri 03rd of April, 2015 16:16:19 PM

I think I am confusing myself...I thought in place of service 22, the PA had to bill under his own NPI # ? can u clarify for me? Thanks

SuperCoder Answered Mon 06th of April, 2015 01:00:41 AM

Yes, you are right here, "Incident-to" services for Medicare may only be reported in the office, not in the outpatient department. To bill for the NPP, the physician must have seen the patient first at a previous encounter and established the plan of care. Care provided to a new patient or an established patient with a new health care problem may never be billed as incident-to a physician service. If an NPP sees a new patient or assesses an established patient for a new problem, the practice should report that service under the NPP’s provider number, not the physician’s. Additionally the physician must be in the suite of offices when the services are performed and must stay involved with the patient’s care.

According to Medicare rules, the services provided by the NPP must be within his or her scope of practice as mandated in the state where the practice is located.

So, here physician and PA can bill the services they have provided separately under their respective NPI#.

Melissa Posted Tue 07th of April, 2015 13:05:53 PM

Thank you

SuperCoder Answered Tue 07th of April, 2015 22:21:18 PM

You are welcome.

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