Coding Physician NPIs in the Registry|
FORDS: Revised for 2013 requires the National Provider Identifier (NPI) numbers for the managing physician, primary surgeon, oncologic radiologist, and medical oncologist. The respective NPI number should be recorded for the surgeon, radiologist, and medical oncologist when:
- The individual provided treatment to the patient
- The individual consulted with the patient about the treatment, even if the treatment was not given
Do not record an NPI number for the surgeon, radiologist, or medical oncologist if:
- The individual had no contact with the patient, although he or she may have contributed to treatment decisions indirectly through a cancer conference or similar setting
- The individual was someone other than the person who administered the treatment
- The individual does not have an NPI number (do not use the group NPI)
The managing physician may also be the surgeon, radiologist, or medical oncologist, but should not be recorded in those fields unless he or she administered the respective treatment or consulted with the patient about the advisability of receiving that treatment.
Most physicians have NPI numbers, and for those who bill for Medicare or Medicaid reimbursement, the NPI number is required by federal law. Because they are used for billing, the most convenient resource for NPI numbers is billing offices. The hospital billing office may have NPI numbers for physicians on staff or who have routine practice privileges at the hospital. If not, the respective physician’s office can provide it. Finally, use the resource at https://npiregistry.cms.hhs.gov/NPPESRegistry/NPIRegistryHome.do to look up an Individual Provider.
Regardless of the source, always check the accuracy of the NPI obtained by looking up the number at https://npiregistry.cms.hhs.gov/NPPESRegistry/NPIRegistryHome.do. To be certain the number is correct for the intended individual, check the following:
- Do the provider’s name and place of practice match the information in your records?
- Does the Provider Taxonomy (the treatment specialty) fit what the individual does?
The National Cancer Data Base’s review of NPI numbers submitted for lung cancer surgeons found a small number of entries as far afield as dermatologist and sleep specialist. These may result from typos, similar practitioner names, or other transcription problems, but additional research can help you correct the information.
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