Nurse practitioner (NP) groups are protesting an AMA report that warns lawmakers and state officials about NPP scope-of-practice limits and clinical qualifications for services often performed by physicians, NPP Report has learned.

Be sure to use the ICD-9 code 585.4 (chronic kidney disease, stage IV, severe) on claims billing the new stage IV chronic kidney disease (CKD) education services G0420-G0421 (NPP Report 11/23/09). Your claims will be denied without this diagnosis code. 

Summary: The two major non-physician practitioner (NPP) specialties, nurse practitioners (NPs) and physician assistants (PAs) have been billing more common imaging services over the last four years. NOTE: The percentage figures above the bars indicate the net year-to-year change. Because 2004 is outside the timeframe analyzed, 2005 has no data.

This month's question is answered by Margie Scalley Vaught, CPC, coding content specialist for DecisionHealth.  

Q. How do we document and bill the following scenario: The PA or NP examines a patient while on the phone with the doctor (who is at home) during a patient exam. The doctor agrees with the NPP's findings. Can we bill this as a telehealth service?

Guidance from carriers detailing how to bill what used to be lower-level inpatient consults in 2009 has started trickling out. The problem: The previous codes (99251-99255) don't match the inpatient hospital care codes (99221-99223) you're supposed to bill (PBN 12/21/09). Specifically, there is not a good match in the inpatient initial visit code series for the two lowest-level inpatient consult codes, 99251 and 99252.

You've seen how demanding some of the proposed meaningful use rules are (see breakdown chart) and how little time there is to demonstrate meaningful use and earn your share of the incentive pie. Now the good news: The proposed meaningful use rule is so strict that there's almost no chance for the final rule to be more difficult. The final rule will either maintain the same requirements or water them down, experts tell Part B News.

If you want the electronic health record (EHR) stimulus money  - as much as $44,000 in extra Medicare payments or $63,750 in Medicaid bonus payments per physician - you have to demonstrate "meaningful use" of certified electronic health records (see story).

You would no longer face mandatory annual fraud, abuse and waste training in order to contract with Medicare Advantage plans under a CMS proposal to ditch the requirement. This training requirement, which went into effect Jan. 1, 2009, obligated MAs to conduct compliance training and education to contracted personnel, including physicians and their staff (PBN 2/23/09). Many providers complained that undergoing training from multiple MAs is burdensome and wasteful.

Download this month's tool, a Medication Chart, from the Part B News website, www.partbnews.com. This tool, developed by DecisionHealth Professional Services, will help you track your patient's prescriptions and over-the-counter medications or supplements. Print out this PDF, give it to your patients and have them fill it out before seeing the doctor.

Proposed meaningful use requirements by difficulty, part I. Look for the second part of our difficulty rankings in the next issue of Part B News. As always, you can read new stories at www.partbnews.com before they make the print issue.