# Nurse practitioner billing question



## lkeithcpc (Mar 31, 2009)

Can a nurse practitioner do joint injections? Assuming they can, if the NP and MD go into a room together and the NP does the injection and the MD does the E?M, whose name goes on the documentation? And does this get billed under the MD or the NP? Any help would be greatly appreciated as I am not the familiar with the guidelines for NPs.


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## RebeccaWoodward* (Mar 31, 2009)

If the answer is "yes" to the qualifications below...then Yes they can perform the service:

The services of an NP may be covered under Part B if all of the following conditions are met:
 • They are the type that are considered physician’s services if furnished by a doctor of medicine or osteopathy (MD/DO);
 • They are performed by a person who meets the definition of an NP (see subsection A);
 • The NP is legally authorized to perform the services in the State in which they are performed; 
• They are performed in collaboration with an MD/DO (see subsection D); and 
• They are not otherwise precluded from coverage because of one of the statutory exclusions. (See subsection C.2.) 2. Incident To If covered NP services are furnished, services and supplies furnished incident to the services of the NP may also be covered if they would have been covered when furnished incident to the services of an MD/DO as described in §60.

http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf
(Section 200)

As for who receives credit...

If the physician performs the E/M, I would credit the physician; even though the NP is peforming the injection. It almost sounds as if the MD is utilizing the NP in a nursing capacity.  *My opinion*...not a cost effective way to use a NP.


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## lkeithcpc (Mar 31, 2009)

*higher reimbursement*

I guess I'm just leary of crediting the physician because I don't want it to look like I'm billing under the physician for the higher reimbursement.


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## RebeccaWoodward* (Mar 31, 2009)

I completely understand.  

In the event that "incident to" doesn't apply...bill under the NP and his/her NPI #.  Again, in this scenario, it appears that the NP was used in a nursing capacity. Anyone else?

http://www.medscape.com/viewarticle/408391_5


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## ARCPC9491 (Mar 31, 2009)

If this is a Medicare patient....your NP should be seperately enrolled and should be credited themselves...of course if they meet the criteria above...and it's within their scope of practice defined by the physician and approved by your state.

If there was an E/M performed which was seperately identifiable then you should code out the E/M w/ modifier 25 and the joint injection CPT for the NP....

If this is a private insurer, you'd have to bill under the physicians name for it all...

I do agree it isn't very cost effective to perform services this way. My opinion is it needs to be one way or the other....

too many "Ifs"...


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## lkeithcpc (Apr 1, 2009)

So if the NP can be seperately credentialed, the E/M should be under the MD and the injection should be under the NP...

I don't really agree this is a cost effective way either but I don't have a lot of say in that


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## donsqueen (Apr 1, 2009)

Is there more information as to why the MD/NP performed the service together? For instance, was this a new patient or new problem for established patient? Is the NP new to the practice? Did the NP really perform the E&M and needed the MD's opinion so the MD went in after and re-performed?

Is there separate documentation for the 2 services? If the documentation clearly shows that the MD performed the E&M service and the NP performed the "nursing" service, then I would not be worried about ramifications of billing under the MD because the documentation supports it. 

Amy


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## lkeithcpc (Apr 2, 2009)

The MD saw the pt first, then went back in to do the injection and the NP went with him. I think the MD was observing her to make sure everything went okay. The NP has never done the joint injections at this practice, but the NP did not provide any evaluation or management.  There is seperate documentation for both. My supervisor thinks that we can bill under the MD since he performed the E/M and oversaw the injection, but it was under Ohio Workers Comp, so our NP has her own credentials with them so I didn't know if the claim should be split.




donsqueen said:


> Is there more information as to why the MD/NP performed the service together? For instance, was this a new patient or new problem for established patient? Is the NP new to the practice? Did the NP really perform the E&M and needed the MD's opinion so the MD went in after and re-performed?
> 
> Is there separate documentation for the 2 services? If the documentation clearly shows that the MD performed the E&M service and the NP performed the "nursing" service, then I would not be worried about ramifications of billing under the MD because the documentation supports it.
> 
> Amy


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