Part B Insider - 2016 Issue 2
Reader Question: Capture NP Counseling with New Code: 99415
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Article Overview
This reader question and answer explains a gastroenterology coding scenario involving an evaluation and management service, a colonoscopy, and additional non-physician counseling time. It focuses on how the article frames reporting the encounter, the role of modifier use, and the new prolonged services codes introduced for 2016. The guidance is relevant to coders, billers, and revenue cycle staff who need to understand how this type of scenario is discussed in CPT-based billing guidance.
Why This Topic Matters
The article addresses a common coding question about whether extra counseling time by a non-physician can be reflected on a claim and what broader billing considerations may affect reimbursement. It is useful for professionals reviewing CPT coding practices, modifier usage, and payer acceptance of new services.
Article Sections
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Question
Presents a gastroenterology encounter involving an office visit, a planned procedure, and additional counseling time by a nurse practitioner. The scenario frames the coding question raised by the reader.
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Answer
Summarizes the article’s discussion of reporting the encounter using the relevant visit, procedure, and prolonged services framework. It also notes that payment and payer acceptance are separate considerations.
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Guidance
Provides general guidance about the newly introduced prolonged services codes and the need to verify payer acceptance. It also discusses the importance of documenting and supporting the reported services.
What You Will Learn
- How the article frames a claim involving an office visit, a procedure, and additional counseling time
- What broader CPT-based concepts are discussed for prolonged non-physician services
- Why payer acceptance and documentation are emphasized in this type of scenario
- How the article connects modifier usage with the reporting of related services
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Compliance staff
- Practice managers
- Gastroenterology office staff
Codes Discussed
Modifiers Discussed
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