Gastroenterology Coding Alert

Question: Should our gastrointestinal nurses have PIN numbers? North Carolina Subscriber Answer: This is an important question when it comes to dealing with incident-to guidelines. The difference between a physician assistant (PA) or nurse practitioner (NP) and a registered nurse (RN) is that the PAs and NPs have their own billing numbers. Nurses do not. Therefore, PAs can bill either using their own billing numbers or incident-to the physician's services using the physician's billing number.

You probably use the "nurse-only" visit code, 99211, quite often. You can bill incident-to for this service as long as you follow Medicare's guidelines, which state that the gastroenterologist must be on-site at the time of treatment, must have originally seen the patient for the first visit to the office or clinic, and must have seen the practice's established patients for any new medical problems. Report these incident-to services using the physician's PIN. PAs and NPs, of course, can perform more in-depth services and bill incident-to or under their own PIN. State regulations determine the allowed services for PAs and NPs. You should make sure your licensed NPPs follow the local regulations for prescribing, ordering tests, and performing services.