Wiki NP billing correctly?

[robin1]

I believe NP have only one specialty code but our manager states NP is also under EP specialty and we must write-off visit when EP performs a pacer etc in the 90 day global period if the NP uses the diagnoses of afib. please where can I find info on NP billing.
Thanks

 

[thomas7331]

I would refer you to the CMS global surgery fact sheet for additional information about what is or is not included in the global period of a procedure: https://www.cms.gov/Outreach-and-Ed...oducts/Downloads/GloballSurgery-ICN907166.pdf

Although it is correct that CMS does not assign a specialty to NPs and will not consider them to be the same specialty as the physician who performed the procedure, you should still consider whether or not the services being performed are part of the normal post-operative care and thereby included in the payment for the procedure. It would not be appropriate to bill the payer or the patient for a service that was already reimbursed in the global fee, bypassing the rules simply because the NP is a different specialty.

The use of the diagnosis is irrelevant here - what matters is what service is being performed, i.e. what problems are being managed and/or complaints are being addressed. As the reference above states, treatment of "the underlying condition or an added course of treatment which is not part of normal recovery from surgery" is not part of the global package, so a diagnosis of atrial fibrillation could indeed be billable if the encounter is for management of the problem itself and not for management of the postoperative course or care. You would need to review the encounter notes in order to know whether or not the service meets the definition of a post-operative visit that should not be charged, or whether it is an unrelated service that can be billed.

 

[robin1]

Thanks so much! Thomas very helpful info.
R