Consult or OV?

I have a pt that the provider billed a 17000 (had lead in his hand) and an OV 99213, that was denied, (of course).
I'm new to the office and working in billing, but I've done denials for the ins. co's before, and I know that the OV will not be paid unless notes specify it to be seperate of the 17000. In this instance, I did not see any notes suggesting the pt was seen for anything else.
Also, the nurse saw and treated the pt, not the dr, but the dr always bills

1- Is it ok that the Dr bills the nurse visits under one name?
2- Can I add a nurse visit to this with the Dr listed, and should I bill a nurse charge or will it be considered the same as the OV is?
3- The Dr never bills consults, but in this case wouldn't a consult be appropriate since it was to consult the decision to remove the lead? What would I bill for that, and will it need a mod, (which one) ?

Thanks for all your help, hope this isn't a newbie error. :)
-Melanie

consult or ov

The provider billed 17000 for "lead in his hand?" That is the code for destruction of an actinic keratosis.

The nurse may not bill for this service: it is a physician/NPP service. All services billed by the nurse need to have the payment returned to the payer. Call a healthcare attorney tomorrow. This is exactly the type of error that the recent OIG report found, and recouped all of the money. Only the physician or PA or NP may do a 17000.

There is no evidence for a consult in what you described.

I hate to be the bearer of bad news, but:

The office visit is not payable

The nurse may not perform the service

Removing "lead" is not reported with 17000.

Any Method

"That is the code for destruction of an actinic keratosis. "

The definition I have for 17000 from Ingenix states:
"Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion EXCLUDES:
cryotherapy acne (17340)
destruction of lesion of:
- anus (46900-46917, 46924)
- conjunctiva (68135)
- eyelid (67850)
- penis (54050-54057, 54065)
- vagina (57061, 57065)
- vestibule of mouth (40820)
- vulva (56501, 56515)
destruction of plantar warts (17110-17111)
destruction or excision of skin tags (11200-11201)
localized chemotherapy treatment (99201-99499)
paring or excision of benign hyperkeratotic lesion (11055-11057)
shaving skin lesions (11300-11313)"

Although it does list actinic keratosis as an example, I comprehend this to apply for other reasons so long as they are not listed in the exclusions...

So you have a link to this OIG report?

P.A.

Also, the person was not a nurse, but a P.A. working with the Dr in house...