Wiki NPP with Specialtist for New Patient

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pochranek

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Patient X was seen as follows:

1-08-15 99203 with Orthopedic surgeon
1-15-15 99213 with NPP - (Physician Assistant)
1-22-15 99203 with Podiatrist

Medicare denied the Podiatrist charge:

Only one initial visit is covered per specialty per medical group. New patient qualifications were not met".

Based on the NP vs EP the Podiatrist should be able to charge for a New visit since he is NOT the exact same specialty as the Orthopedic surgeon. He has a different taxonomy as well.

Am I missing something and if so can you direct me where to find the documentation for training and future reference.

Thank you for your help!!

Peggy
 
pochranek said:
Patient X was seen as follows:

1-08-15 99203 with Orthopedic surgeon
1-15-15 99213 with NPP - (Physician Assistant)
1-22-15 99203 with Podiatrist

Medicare denied the Podiatrist charge:

Only one initial visit is covered per specialty per medical group. New patient qualifications were not met".

Based on the NP vs EP the Podiatrist should be able to charge for a New visit since he is NOT the exact same specialty as the Orthopedic surgeon. He has a different taxonomy as well.

Am I missing something and if so can you direct me where to find the documentation for training and future reference.

Thank you for your help!!

Peggy
Click to expand...

Was the 1-15-15 visit the the PA a followup to the ortho appt? If not, what specialty is the PA in?

Basically, NPP's are not assigned to a specific taxonomy the way physicians are. Once an NPP is seen in your clinic, any new patient visits that are billed after that will likely be denied, even if MD billing the new pt visit is in a different specialty. You should be able to appeal with info showing that, for examply, the PA is in the ortho specialty, and has an ortho MD as his supervising, and therefore you should be allowed to bill a new pt visit for the podiatrist. I know there is guidance about this, If I can find it again I will post links here. I'm pretty sure it's been discussed in these forums also.

HTH!
 
Meagan

Thank you so much for your help and also for the link! It was very useful to us!

Peggy
 
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