I am helping with the billing for a Pain Management practice located in Maryland (DC Metro area) At the beginning of the year, they started billing strictly under their nurse practioners for the 20611 (joint injections). Previously in 2014 they billed the 20610 and 76942 together. When billing using the MD for this procedure there was never a problem but since changing to the NP billing they have received a huge amount of denials for CO-170. The J code that is billed along with the 20611 is being paid. Should they be using a modifier to indicate this is being billed by an NP only and if so which one? Medicare has given me 4 different answers and none of the reps have been able to provide me with ANY documentation stating NP's cannot do this procedure. We are getting prepared to do a mass appeal but I still don't feel comfortable with the situation.
I hate to go through all of this work if I am unaware of something that does not allow them to bill for this procedure.
Any and all information is appreciated. I am beyond frustrated.
NP Question Please Help
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