# MD vs NP billing



## Bellaboo (Jun 19, 2013)

Physician is questioning when NP sees patient and documents the visit, the MD then reviews and documents he has discussed case with NP and agrees on treatment
signs the note, MD bills for service. Is there anything specific the MD needs to
document in the NP note, in order for him to submit the charge under his name?
The NP has documented all elements of e/m code being billed.
Thanks for any help.


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## la_0922 (Jun 19, 2013)

Yes Medicare is now stating that the simple statement "seen and agree" is no loner sufficient, now the MD needs to document at least one element of the E&M service. Usually, the Impression and Plan, or the History is the easiest to document. 
This can be found in CMS Claims processing Manual

Hope this helps 
Louise CPC


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## mhstrauss (Jun 19, 2013)

Is this referring to hospital or clinic services? If in clinic...this may fall under Incident-to Guidelines.  If it does, CMS does not require the MD to co-sign the note, or make any notation that he reviewed the documentation.  Check with your MAC for specific guidelines.  If inpatient, I agree with Louise above.


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## la_0922 (Jun 19, 2013)

thank you for clarifying that, I apologize that I didnt 

Louise CPC


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## mitchellde (Jun 19, 2013)

Incident -to is one thing and a shred encounter is yet a different thing.
Incident -to the physician has to have seen the patient in a previous encounter for the same diagnosis and has a written plan of care for the NP to follow up on, if the dx has changed or exacerbated or if the NP feels the treatment must change then this is no longer incident -to.  Also the provider must be within the office suite area while the patient is being seen.
You cannot bill incident -to (under the MD) for a new patient or a new problem or anytime the provider is not in the office, or for encounters in the facility setting.
A Shared encounter (CR1776) is an encounter for an established patient where the NP sees the patient for part of the visit and the MD sees the patient face to face for part of the visit, as stated above you must have more than a signature on the NP note.  CR 1776 states if there is no face to face encounter (documented) between the physician and the NPP, even if the provider signs off on the documentation, the visit must be billed under the NPP number.


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## Bellaboo (Jun 21, 2013)

Thanks Everyone!  Appreciate the help.


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