Neurology & Pain Management Coding Alert

Question: Our nurse practitioner recently performed an IV infusion on a patient. The ordering physician who oversees the patient's care was on vacation, but another physician was physically present in the suite at the time of the infusion. If we-re billing Medicare for incident-to services, which neurologist's PIN should we bill the service under?


Nevada Subscriber


Answer: Unfortunately, to stay on the safe side, you-ll need to report the infusion under the nurse practitioner's number. This would subject it to Medicare's reduction for NPP services, reimbursing 85 percent of the infusion code's value.

Why you may have heard otherwise: The Centers for Medicare & Medicaid Services has waffled on whether the ordering and supervising physicians need to be the same for incident-to services.

In late 2004, it released a transmittal that stated that the ordering physician who is supervising the patient's care did not need to be the physician present in the suite during the service. CMS has since retracted that transmittal, saying it was published -in error,- and has not offered any further clarification.

In the absence of explicit permission from CMS, you-ll want to assume that the physician who orders the service and the physician present in the office suite during administration need to be the same person. If your practice has not met this requirement, bill the service under the NPP's PIN.

Remember: A 15 percent cut in reimbursement is highly preferable to false-claim charges or full refund requests from Medicare.