Cardiology Coding Alert

Question: I have a cardiologist with a nurse practitioner (NP) working for him, and she was wondering if the physician has to sign off on everything she does for Medicare patients. She specifically asked if she can do a consult and see the patient -- does the cardiologist have to come in and sign off on this? Indiana Subscriber Answer: You'll find physician co-signature requirements dictated on a state-by-state basis by the organization credentialing the nurse practitioner (state board of nursing). These guidelines/requirements apply regardless of who bills for the service. However, you should also take into account a slew of Medicare-specific guidelines dictating what documentation must be present to bill for services under a physician's name, rather than under the mid-level's name. For consultative services, Medicare restrictions basically prevent the physician from billing for the work of mid-level providers if they do anything in excess of taking certain elements of history and vital signs. So you wouldn't be able to code a consultation with 99251-99255 unless the consultation requirements are met.