NPP consults + the physician adds an addendum

The NPP sees the pt in the a.m. and does the complete consult. The physician rounds by in the afternoon to check on the patient and changes the tx. How is that best handled? Can the physician add an addendum (for change of tx) to the NPP's note or should they create their own and (can they?) bill seperately?
Thank you.
Kathy

consult

There is no "shared visits" for consults. The provider who performed the service, bills the service. To whom was the consult requested?

NPP consults +

You can't submit a charge for both, so you have to submit either for the consult from the NPP or the subsequent hospital visit from the MD. Whichever you do, base it on that note only, without any combining of notes/elements.

You get paid at 85% of the fee schedule for the NPP and 100% for the MD, but typically, it makes more sense to bill the NPP, because they'll have documented more completely.

addendum

So.....as long as the NPPs notes are complete, the addendum from the physician has no bearing on the service charged by the NPP?

addendum by MD after NPP note

That is correct. the MD note does not affect the level of billing for the service performed by the NPP. The shared services rule is a Medicare rule.

Shared services:

http://www.codapedia.com/~article_356_.cfm

NPPs and consults:

http://www.codapedia.com/~article_222_.cfm