# NPP Nursing home visits



## Lisa Bledsoe (Apr 20, 2009)

Can an NPP see nursing home patients in the nursing home Non-Incident-To for acute illness (flu, pain, URI, etc) if they are currently a patient in the practice and routinely seen in the office by the MD for chronic conditions?  I think so, but would like some feedback.  Thanks!


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## RebeccaWoodward* (Apr 20, 2009)

I had to do some research on this the other day...

 Further, per the Long Term Care regulations at 42 CFR 483.40 (c)(4) and (e) (2) the physician may not delegate a task that the physician must personally perform. Therefore, as stated in S&C-04-08 the physician may not delegate the initial visit in a SNF. This also applies to the NF with one exception.

*The only exception, as to who performs the initial visit, relates to the NF setting. In the NF setting, a qualified NPP (i.e., a nurse practitioner (NP), physician assistant (PA), or a clinical nurse specialist (CNS), who is not employed by the facility, may perform the initial visit when the State law permits this.* The evaluation and management (E/M) visit shall be within the State scope of practice and licensure requirements where the E/M visit is performed and the requirements for physician collaboration and physician supervision shall be met.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.13


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## sarahjane (Apr 20, 2009)

*NPP Nursing Home Visits*

If the NPP has a provider number you can bill for their services directly for the acute visit.  Nursing homes have no incident too billing allowed.

sarah jane


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## Lisa Bledsoe (Apr 20, 2009)

Thanks ladies.  I was pretty sure I was right but needed support from my coding colleagues.  These visits would not be the inital visit or billed incident to.


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## RebeccaWoodward* (Apr 20, 2009)

Now I have a question..........

*Incident to Services*

*Where a physician establishes an office in a SNF/NF, the “incident to” services and requirements are confined to this discrete part of the facility designated as his/her office.* “Incident to” E/M visits, provided in a facility setting (<--No question about this-understood), are not payable under the Physician Fee Schedule for Medicare Part B. Thus, visits performed outside the designated “office” area in the SNF/NF would be subject to the coverage and payment rules applicable to SNF/NF setting and shall not be reported using the CPT codes for office or other outpatient visits or use place of service code 11.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

For those of you that provide these services, where is your "designated area" located?


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## Lisa Bledsoe (Apr 20, 2009)

rebeccawoodward said:


> Now I have a question..........
> 
> *Incident to Services*
> 
> ...



I'm new to this specifically.  If you mean is it a nursing home, yes.  I would use POS code 32.


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## RebeccaWoodward* (Apr 20, 2009)

Not POS...I'm curious where a "designated spot" would be located?

"Where a physician establishes an office in a SNF/NF, the “incident to” services and requirements are confined to this discrete part of the facility designated as his/her office." 

Maybe I'm overthinking this but for "incident to" to apply, how does one determine the actual area the MD provides care? and...Is there any special documentation required so that there is no question about the "incident to" requirements for this "discrete" location.


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## FTessaBartels (Apr 20, 2009)

*"Visiting physician"*

The facility where my parents reside has a "doctor's office" where the visiting MD (or his NP or PA) holds "office hours" on a scheduled basis.  This is a physician who has contracted to provide this service to residents of the facility. He is not employed by the facility. 

So if the service is provided during those regularly scheduled "office" hours (at the facility in the designated space) then the "incident to" rules could apply. Of course, if it's a new problem, the NP can bill that service under her own name/number.

(As an aside ... my parents have a great gerontologist, so when they first moved to this place we paid for the transportation to take them down to his office ... we didn't want to use the "visiting" doctor who had the contract there.  The facility was so impressed with the care my parents received that they have since signed on with my parents' physician to be the official "visiting doctor."  Of course, there are still the occasional transport downtown for acute problems on a day where there are no "office hours" at the facility.)

F Tessa Bartels, CPC, CEMC


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## Lisa Bledsoe (Apr 20, 2009)

Not billing as incident to.  
It is my understanding that we can report 99307 - 99310 with POS 32 without a designated office in the NF.  Is this not true?


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## RebeccaWoodward* (Apr 21, 2009)

Yes.  That is my understanding as well.  The charge will be billed under the NPP and their NPI #.

Thanks Tessa....Your answer came in about the same time as my other trusty source.  Thumbs up!


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