Get Paid for Nurse-Only Visits

Nugget: Make use of nurse-only visits (99211) to expand your out-of-practice billing opportunities, offer patients a higher level of service, and increase your bottom line.

Nurses frequently evaluate patients for routine follow-up visits or other minor services in infectious disease practices, but how should you bill when the doctor doesnt see the patient? Normally, the best way to code for a short nurse-only evaluation and management (E/M) visit is to use 99211 (office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician).

The Typical Five-minute Nurses E/M

Typically, for a nurse-only visit, the presenting problems are minimal, and the normal visit time is five minutes, says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia. She notes, however, that the time spent may vary according to the needs of the patient.

The nurse might render any range of services, including, but not limited to diet instructions, uncomplicated wound care, dressing changes, review of possible HIV/AIDS issues and review of self-medication administration, including a discussion of possible medication side effects, says Dianna Hofbeck, RN, CCM, president of North Shore Medical Inc., a specialty medical billing service in Absecon, N.J. In an infectious disease practice, where patients have conditions such as an infected, diabetic foot and ankle ulcer, the nurse might review energy conservation methods that allow patients to more easily perform activities of daily living, Hofbeck explains.

The alert ID physician and staff can create a reimbursement advantage by assessing each patient for the out-of-practice (OOP) billing opportunities, claims Hofbeck. By coding a nurse-only visit, you can gain reimbursement for services that you would not customarily bill. A prime example, she suggests, is gait training (97116). In the physicians office, as performed by a registered nurse (RN), this procedure cannot be called physical therapy (PT), but a licensed, experienced RN is perfectly qualified to gait train patients in a doctors office. In addition, Hofbeck says, nurses can be involved with patients on antibiotic infusion therapy that require high levels of monitoring to maintain their PICC [peripherally inserted central catheter] lines and ensure freedom from clots. A blocked infusion line is not only costly to replace but also puts the patient at risk. Billing 99211 for such add-on services contributes to your bottom line. OOP can increase practice revenue as much as 10 percent annually, Hofbeck asserts.

When the Nurse Notices a Change in Condition

Mulholland says that the 99211 shouldnt extend too far beyond the suggested five minutes. There are no prolonged service codes or modifiers for extra time for 99211. Any visit that would [...]

- Published on 2000-07-01