Wiki NP Billing with Modifier SA

[Anduiza05]

hello do any of you know if this billing example is allowed for the DR and the NP

Same DOS
99214 (DR E/M)
99214-SA (NP E/M)

They were both reimbursed at 100%.
I was not sure if this is correct I thought that the NP was to receive a lower rate then the Doctor.
Also, if both are paid equal isn't this double dipping?

Any input would be appreciated

thank you

 

[CodingKing]

Services billed under incident to guidelines w/ the physicians name pay based on MD rate. Were these 2 E&M by different specialties. I would have expected the second to deny and not pay.

 

[thomas7331]

If the MD and the NP are working in two different specialties, or if they are treating the patient for unrelated problems, then the billing of two E&M codes on the same date of service might be justified, but if not, then I'd agree that this could be 'double dipping'.

As far as the reimbursement, that would depend on the payer and/or the provider contract. Medicare does pay NPs at 85% of the physician fee schedule, but other payers may have different fee schedules set up and may or may not reduce payment for the mid-level providers.

 

[Anduiza05]

Np sa mod

The doctor and the NP are billing with the same NPI therefore it would be the same specialty. The same Tax ID, NPI and E/M codes the only difference is the SA modifier. I wonder why these were not denied but for compliance concerns I think these should be reimbursed back to the payer.