Which provider can do E & M service

EVALUATION AND MANAGEMENT SERVICE PROVIDERS 

E/M services refer to visits and consultations furnished by physicians and the following qualified NPPs:

** Nurse practitioners;

** Clinical nurse specialists;

** Certified nurse midwives; and

** Physician assistants.

A NPP’s Medicare benefit must permit him or her to bill for E/M services, and the services must be furnished within the scope of practice in the State in which the NPP practices in order to receive payment from Medicare.


EVALUATION   AND  MANAGEMENT  BILLING  AND  CODING  CONSIDERATIONS

This chapter discusses selecting the code that best represents the service furnished and other evaluation and management (E/M) considerations.

SELECTING THE CODE THAT BEST REPRESENTS THE SERVICE FURNISHED

Billing Medicare for an E/M service requires the selection of a Current Procedural Terminology (CPT) code that best represents:

** Patient type;

** Setting of service; and

** Level of E/M service performed.


PATIENT TYPE

For purposes of billing for E/M services, patients are identified as either new or established, depending on previous encounters with the provider. A new patient is defined as an individual who has not received any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous three years.

An established patient is an individual who has received professional services from the physician/NPP or another physician of the same specialty who belongs to the same group practice within the previous three years.



SETTING OF SERVICE
E/M services are categorized into different settings depending on where the service is furnished. Examples of settings include:

** Office or other outpatient setting;

** Hospital inpatient;

** Emergency department (ED); and

** Nursing facility (NF).