Pulmonology Coding Alert

Question: If one of our NP’s does an intubation or other procedure and the physician is present during the procedure, which one do I bill under? The physicians are putting it under their billing.

Cincinnati Subscriber

Answer: Health plans are free to set their own policies for credentialing NPPs and providing reimbursement for their services. Some plans credential NPPs and allow their services to be billed under the NPPs’ provider numbers. Other plans do not and instruct practices to bill for services provided by NPPs as if the physician had provided them, using the physician’s name and provider number on the claim. Medicare refers to this arrangement as “incident-to” billing and has a set of rules that apply to it that will be explained later. Health plans that allow this type of billing may do so with fewer restrictions than Medicare.

Unfortunately, this leaves you needing to determine the policy of each health plan with which you contract. So, you will have to get in touch with the each payer and see what their policies are for covering the services provided by the NPPs in the presence of your physician.

If the payer policy allows your NPP to bill out the intubation procedure under the particular NPP’s provider number, you can bill it so or else you will have to report the services under the physician’s name and provider number.