Coding Corner Answer

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Example A:
CPT: 99213
Diagnosis: 715.96

• 99213 – This was an established patient, therefore only two of the three components—history, examination, and medical decision making—are needed to establish the level of this visit.

Presuming the nurse practitioner has met the state requirements for these billable services, he or she can bill under the physician’s National Provider Identifier (NPI) and receive reimbursement at 100% of the allowable Medicare Physician Fee Schedule.

Example B:
CPT: 99203
Diagnosis: 719.46

• 99203 – This was a new patient, and for that reason, all three components—history, examination, and medical decision making—are needed to determine the level of this visit.

Because this was a new patient and the supervising rheumatologist did not see the patient, this visit would have to be billed under the nurse practitioner’s NPI, and it would be reimbursed at 85% of the allowable Medicare Physician Fee Schedule.

For more information, see this month’s Practice Page article, “Incident-to: What are the Guidelines?”.