READER QUESTIONS:
NPP Vital to Hepatitis Follow-Up Care
Published on Sun Jul 10, 2005
Question: I have a claim in front of me that states a patient with acute hepatitis C reported for a follow-up visit. The nonphysician practitioner (NPP), who handled the whole visit, took a blood test, asked the patient how she was feeling and counseled her on some of the treatment side effects. The entire visit took 17 minutes, and it looks like a level-three evaluation and management service, but I thought NPPs could only provide level-one E/M service. Is there any limit on the E/M service level an NPP can provide?
Michigan Subscriber
Answer: You may be confusing the "nurse visit" rule with the guidelines governing an NPP's role in hepatitis follow-up care.
In a gastroenterology office, nurses can only provide level-one E/M services such as injections and blood tests. But after the gastroenterologist provides a hepatitis diagnosis, an NPP is qualified to perform a lot of the follow-up care that a nurse cannot. An NPP may be called on to adjust a hepatitis patient's medications, order lab tests, and counsel and educate patients.
When an NPP provides follow-up care for hepatitis patients, the E/M visits can range anywhere from a level-two to -five service, so you can report a level-three E/M code for this visit. On your claim, you should:
report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: an expanded problem-focused history; an expanded problem-focused examination; medical decision making of low complexity) for the NPP service.
attach ICD-9 code 070.51 (Acute hepatitis C without mention of hepatic coma) to 99213 to represent the patient's hepatitis. Remember: NPPs in gastro offices can also teach hepatitis C patients self-injection procedures, so the patient can administer her own Interferon shots at home.
When the NPP teaches the patient about self-injection, report the appropriate E/M code. If, however, your NPP injects the Interferon in the office, you should: report 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) for the injection on commercial claims; or
report G0351 (Therapeutic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection on Medicare claims.
