Practice Management Alert

Question: One of our nonphysician practitioners (NPPs) performed an evaluation and management service on an established Medicare patient with an established plan of care for her hypertension. During the course of a level-two service, the NPP checked the patient's blood pressure and asked her how she was feeling. Then, the patient requested a hepatitis A and hepatitis B vaccination. The NPP gave the patient those shots, too. Can we bill this visit incident-to the physician?


Tennessee Subscriber

Answer: No, you cannot bill this visit incident-to the physician. While the original reason for the visit followed an already established plan of care for hypertension, the NPP gave the patient the hepatitis vaccine without an order from the supervising physician. When the NPP acts without a directive from the physician, you cannot bill a visit incident-to.

On the claim, you should:

- report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem- focused examination; straightforward medical decision- making) for the hypertension re-evaluation.

- report 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the vaccine administration
 
- report 90636 (Hepatitis A and hepatitis B vaccine [HepA-HepB], adult dosage, for intramuscular use) for the vaccine itself.

Remember: Bill the entire claim under the NPP's Medicare number, not the physician's number. The office can expect 85 percent reimbursement for services billed under the NPP's number.