Urology Coding Alert

Take this quiz to see if you should be hitting the NPP coding books

Each time a nonphysician practitioner (NPP) provides services or treatment to a Medicare patient, you should be on the lookout for the opportunity to code the service incident-to the physician. But if you don't follow Medicare's strict guidelines for incident-to billing, you'll only see partial payments and denials. Take this quiz to test your NPP knowledge.

Question 1: One of your practice's nurse practitioners (NP) sees an established patient whom the urologist has been treating for a urinary tract infection. The urologist has seen the patient in the recent past and has established the diagnosis and initiated treatment or a care plan. The NP performs a follow-up history and examination and continues the prescribed treatment. The urologist is in the office suite but does not see the patient. How should you code this encounter?

Answer 1: You should report an established patient office visit, depending on the level of service--most likely 99212 (Office or other outpatient visit for the evaluation and management of an established patient ...) or 99213--under your urologist's name and PIN/NPI numbers. You'll be paid 100 percent of the E/M fee.

This patient had a care plan established by the urologist, is not a new patient, is not presenting with a new problem and isn't undergoing status change. In addition, the urologist is present in the office suite so the NP can provide the service, and you can use the urologist's NPI/PIN when filing with Medicare.

Question 2: A physician assistant (PA) from your office sees a patient in the hospital whom your urologist admitted the day before. Can you report this visit incident-to the physician?

Answer 2: No. Never report incident-to services in a hospital setting, either outpatient, inpatient or in the emer-gency department. Medicare doesn't allow incident-to billing in these places of service, only in the physician's office.

Question 3: A new patient complaining of urinary retention comes to the office. The urologist is present in the office but is involved doing a minor surgical procedure and is unable to see this emergency. In his place, one of your NPPs treats the patient, inserts a Foley catheter to relieve the obstruction and establishes a care plan of treatment. Can you bill this NPP's service as incident-to the urologist who was in the office suite at the time of the appointment?

Answer 3: No. In this example, the patient is new to your office and received treatment for a new problem, meaning the NPP was not following an established plan of care. Therefore, you should report the encounter using the NPP's NPI/UPIN, and you'll receive 85 percent of the global fee (the fee the physician would have received if he had personally rendered the care). Anytime the NPP sees a new patient independently for a new problem, you should code for the service in the NPP's name with his UPIN.

Question 4: Your urologist leaves the office to perform rounds at the hospital. The nurse practitioner sees one more patient before leaving for the day. The patient is established with the urologist, and the NP follows the established plan of care. Can you report this service as incident-to?

Answer 4: You can't report this service as incident-to. To bill incident-to the physician, you must also be sure that the NPP provided the service under the "direct supervision" of a physician. To meet "direct supervision" requirements, the urologist must be present in the office suite and immediately available to render assistance if necessary. But the urologist does not have to be physically present in the exam room with the NPP, and the supervising physician does not have to be the same one who established the patient's plan of care.

Answers reviewed by Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.