Wiki Doc gave injections during NP visit

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KPriceAZ08

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Greetings -
Patient was seen in office by NP. She documented that the doctor gave the patient CMC joint injections during the visit.
Wondering if anyone comes across this and how you've billed it.
This is not incident to.

Thanks for any help
Kristen Price
Ortho Coder
 
Depending on the scenario, there are a few options:
1) Scenario 1 - NP evaluated hand issue AND also a knee problem. Discussed with MD who gave the CMC joint injection. MD documents they personally performed the injection and signed record:
E&M -25 with both dx under NP
Injection with hand dx under MD
2) Scenario 2 - existing patient returning for injection. NP does quick evaluation prior. MD documents they personally performed the injection and signs records.
Injection only under MD
 
Agree with @csperoni. It depends on the documentation and what the NP visit was for. Was the NP seeing the patient for the hand/CMC? I am assuming OA, RA or possibly DeQuervain's? Or, was it one of those where the patient is being seen for multiple things and they did an, "oh by the way I also want an injection" but the NP was seeing them for a different reason? Depending on the documentation, you might only bill the injection under the MD and nothing else. If there is enough to append a modifier 25 to an E/M you would do that under the NP and the injection under the MD. This could also be payer dependent; do you normally bill this NP under their own name/NPI etc.? They are not brand new and non-credentialed?
This is kind of odd usually it's the other way around where the MD sees the patient and then gets busy and has the PA or NP come do the injection. Sometimes with the small joints in the hand, the hand MD wants to do it. It's usually the big joints that the NPPs do.
 
Thank you both for your detailed help. The NP has been here ages and she and doc typically share space when seeing patients separately. Patient was seen a month prior for CTS & CMC arthritis and had carpal tunnel injections then. Returned a month later no improvement so NP brought doctor in, probably to confer. He injected CMCs this visit.
I plan to bill injections under him since we've seen patient for both.
Thanks again -
Kristen
 
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