Ophthalmology and Optometry Coding Alert
Understand NPI Types
Question: Are there different kinds of national provider identifiers (NPIs) for individuals versus practices? Arizona Subscriber Answer: Yes. According to the Centers for Medicare & Medicaid Services (CMS) document “The Who, What, When, Why & How of NPI: Information for Health Care Providers,” there are two types of NPI. Type 1 is for individuals, like physicians, dentists and other sole providers. Type 2 is for organizations like physician groups, hospitals, nursing homes, and individuals who “incorporate” themselves. An NPI is a 10-digit number that identifies a provider or practice for the other healthcare entities in which they interact, including payers, in HIPAA standard transactions. NPIs were originally mandated by HIPAA. Some providers may need additional NPIs if they have “subparts” that need to be “uniquely identified in standard transactions with their own NPIs.” In this context, CMS defines subpart as a “component of an organization health care provider that furnishes healthcare and is not itself a separate legal entity.” For example, a hospital with multiple departments may need several unique NPIs to identify each department. An individual who is both a provider and incorporated would need two NPIs: one of each type.
Ophthalmology and Optometry Coding Alert
- CPT® 2025:
Get to Know the 2025 CPT® Revisions
Be prepared for a host of new telemedicine codes. It won’t take a lot for [...] - E/M Coding:
Let These 3 Tips Lead You to New vs. Established Patient Clarity
You can collect more for new patients — but check these guidelines first. What’s the [...] - Practice Management:
Improve Provider, Coder, Biller Relations, Improve Outcomes and Revenue
Three different roles, the same shared goals. In her presentation “Documenting and Coding From the [...] - You Be the Coder:
Does Proof of Prescription Prove an E/M Service?
Question: An established patient came in for a previously scheduled eye injection. The physician’s documentation mentions [...] - Reader Questions:
Leave Modifiers Off This POAG Exam Claim
Question: If a patient comes in with primary open-angle glaucoma (POAG), and we perform gonioscopy, a [...] - Reader Questions:
Beware This Humana Billing Snafu
Question: We just got a denial from Humana for billing 67028 together on the same claim [...] - Reader Questions:
Understand NPI Types
Question: Are there different kinds of national provider identifiers (NPIs) for individuals versus practices? Arizona Subscriber [...]
