would you bill this Medicare visit under the MD or NPP?

I have a question regarding a New Patient Office Visit

Both CRNP & MD see pt on the day of the visit. The CRNP writes a full note including History, Exam and Medical Decision Making.

The physician then sees the patient and documents the following:

I have read my advanced practitioner's assessment and plan and agree. I have personally examined the patient. The patient is a better TAVR candidate due to his advanced age, his previous CABG, his vascular history and his overall frailty. He also has decreased renal function. We will schedule him for his heart catheterization and Dobutamine stress as he is a low gradient AS at this time. I have answered questions of the patient and his wife. I have reviewed the data and spent greater than 50% of an hour in counseling of care with the patient.

Per the Novitas website:
An initial history and physical performed by a non-physician practitioner, although the physician is documented as being present or in the office suite and immediately available, is not covered under the "incident to" guidelines. As outlined below, the physician MUST perform the initial service. This includes the history and physical, examination portion of the service, and the treatment plan. It is expected that the physician will perform the initial visit on each new patient to establish the physician-patient relationship.

Can you review and let me know if this documentation meets the requirements to code this with the physician as the billing provider? We weren’t sure since MD counseled the patient & wants to bill based on her time.


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