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Pediatric Coding Alert

Reader Question:

Check Consult Rules for NP's Lactation Visit

Published on Tue May 08, 2012

Question: We have a nurse practitioner (NP) who specializes in lactation consulting. Pediatricians in the same group sometimes ask her to perform a consultation. In a "group" comprised of physicians with different specialties, a physician in the same group can request a consultation regarding his specialty. Can we report the NP's visits as consultations, provided they meet the requirements for request for opinion, render of findings, and report to the requesting source?Massachusetts SubscriberAnswer: Whether your NP can report a consultation depends on whether the insurance company credentials NPs, as well as your state's and payers' limitations. To report a consult, NP must report 99241-99245 (Office consultation for a new or established patient ...) under her own provider number, not incident to a physician.When a physician requests an opinion from a same-specialty non-physician practitioner (NPP), such as an NP or physician's assistant (PA), payers may not pay the consultation (99241-99245). Educational level [...]
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