Cardiology Coding Alert

Question: I just now finished reading the article "Think You Can Share Consults and Get the Full Fee? Think Again" in the November 2005 Cardiology Coding Alert. My cardiologist is planning to get a PA on board to help him do hospital rounding. Will the same rule apply for the PA regarding using the UPIN/PIN?


Indiana Subscriber

Answer: Yes, the term NP (nurse practitioner) encompasses both nurse practitioners and physician assistants. 

CMS' recent clarification referenced in the previous article is new and in direct conflict with the way that many cardiology practices now use NPs. However, their clarification has been set in stone, and regulations are now being modified specifically to illustrate this.  

You'll still have many benefits offered by bringing NPs on board. They can share admits, subsequent hospital care and discharges. They can also work under the incident-to rule in the office setting or bill under their own number at a slightly reduced reimbursement rate (85 percent of the physician fee schedule). You should apply for a Medicare ID number for your NP as soon as possible because most carriers tend to drag out the process.

Also, keep in mind that these regulations are specific to Medicare only. Non-Medicare payers typically have much more liberal policies in regard to NP billing.

You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.