Wiki E & M Coding for NPs

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ecaissie

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Hi! I have a prospective client for my billing business who is starting a business as a Nurse Practitioner. He has an internal medicine physician working with him, but he will be billing using his own NPI. If he sees a patient of that physician, since he is billing using his NPI, can he code this as a new visit, even if the physician has seen him within the past three years? Thanks for your help.
 
New patient visit

Unfortunately you can't. A new patient is one who has not received any professional services from the physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

The physician and the NP are under the same group practice.
 
Actually you Can

The NPP has a different Taxonomy code and is in the same "group." In an Ortho clinic you may have a hand surgeon--different taxonomy than an orthopedic surgeon, a podiatrist, and an sports medicine orthopedist. All 3 have different taxonomy codes and all are part of the same group and therefore able to be billed separately.

However, the question is an ethical one, if the NPP is an extension of the PCP, most places bill the NPP as if they were part of the same Taxonomy code.
 
Let me see if I have this straight...since one is an NP and the other is an internist they are have a different taxonomy code? So for billing purposes you are saying that's OK. But ethically, the NP should consider patients that have been seen by that internist within the last three years as established patients.
Have I got that right?

Of course, if they have not seen that physician before (or more than 3 years ago) the NP can consider those patients as new patients.
 
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