Wiki How to code initial NP E/M without an exam.

[kvyrostek]

I would like some opinions on how I could code a NP evaluation, where the patient refused the physical evaluation portion of the visit. Doctor was with them for 45 min. I do have a comprehensive HPI from their time, and ROS from the intake forms.

 

[Orthocoderpgu]

I would like some opinions on how I could code a NP evaluation, where the patient refused the physical evaluation portion of the visit. Doctor was with them for 45 min. I do have a comprehensive HPI from their time, and ROS from the intake forms.

If the evaluation took place in a providers office an exam is not needed. Starting 2021 E/M's are based off of MDM only.

 

[jkyles]

I would like some opinions on how I could code a NP evaluation, where the patient refused the physical evaluation portion of the visit. Doctor was with them for 45 min. I do have a comprehensive HPI from their time, and ROS from the intake forms.

You can use time-based coding for office visits.

 

[kvyrostek]

Thank you both for your assistance!

 

[carmenbutler]

A nurse practitioner cannot provide the Initial Visit to a patient.
The EM guidelines specify that only a physician can perform the initial visit and the NP can only provide established visits.
But yes, the answer from Jkyles, is correct. use time-based coding.

 

[AC]

A nurse practitioner cannot provide the Initial Visit to a patient.
The EM guidelines specify that only a physician can perform the initial visit and the NP can only provide established visits.
But yes, the answer from Jkyles, is correct. use time-based coding.

I believe the original poster was using NP to signify “new patient” not “nurse practitioner.” But had it been a nurse practitioner seeing a patient, they can absolutely see new patients (in my state) as long as you bill under their NPI, not the physician’s. If you’re referring to incident to guidelines, you’re right that the physician would need to see the patient first and establish a plan of care. I think there are a lot of different scenarios that could occur with a nurse practitioner visit; it just depends on specifics of the visit and payer guidelines (some payers may want the mid-level provider to bill under the physician’s NPI all the time whether the service is incident to or not).
Also, OP - it’s fine to code the visit based on time if the physician documented time. I noticed you said the physician spent 45 minutes with the patient but did not mention whether he documented time spent within his office note.

 

[csperoni]

A nurse practitioner cannot provide the Initial Visit to a patient.
The EM guidelines specify that only a physician can perform the initial visit and the NP can only provide established visits.
But yes, the answer from Jkyles, is correct. use time-based coding.

I am not aware of any state that prohibits Nurse Practitioners from providing new patient visits in an outpatient office. For office based incident-to, an NPP (NP/PA/CNM) may see a new patient, but may not bill incident-to the physician. I know a lot of offices misinterpret incident-to for new patients.

Regarding the original question, as others have answered, bill either on total time or MDM only (assuming for outpatient E/M after 1/1/2021).