# 2 providers documenting in same EMR note and billing for services separately



## jhynek (May 1, 2017)

Just looking for more info on this.  I work in dermatology and we currently have an MD who wants to perform the E/M service and have the NP come in and perform the biopsy.  Our EMR only allows sign off by one provider per note unless an addendum is done indicating another sign off, which I do not find to be very good documentation, as every chart note will need an addendum for the NP to indicate she performed the biopsy only and wants those charges to be under her.  Has anyone else experienced this and how did they document in the same note and bill for these services under separate providers? I feel as though they should each document their own notes separately, but they do not want to do it that way.


----------



## csperoni (May 2, 2017)

*Why bill each provider separately?*

I'm not sure why you would WANT to bill separately for the NP performing the biopsy if the physician is there, already saw the patient, and developed the plan of care?  Isn't this straightforward incident-to billing?  Why give up the 15%?  For the documentation, your NP should be able to document her portion on the MD's note.  Just like your MA, LPN, or RN may document the chief complaint portion.  This is all from the billing standpoint.    
Now, from an economics of the practice standpoint, your dermatologist may want to evaluate the monetary value your NP brings by the amount of work she does.  In our EMR system, this is accomplished by indicating who actually rendered each service, but then adding a supervising provider.  The supervising provider is what gets sent to the insurance company.  The provider who actually rendered each service will get credited with the payment accordingly.  
If that doesn't matter in your situation, I would just bill everything under the MD in the scenario your provided.
Obviously, if your NP is seeing patients when the MD is not present, or for a new problem that was not evaluated by the MD, then you must bill under the NP.


----------



## Kris Cuddy (May 31, 2017)

If they truly want to bill under the NP, I suggest a separate procedure note. The procedure note should reference the order for the biopsy from the physician's E/M on the same day.

Hope that helps.


----------

