Optimize Reimbursement for Nurse-only Visits
Published on Sat Jul 01, 2000
Nugget: To properly use 99211, the nurse must know when to involve the physician, or the practice may not be able to bill for the additional services.
Nurse-conducted evaluations of patients for routine follow-up visits or other minor services are common occurrences in family practices. Nonetheless, some clinicians are concerned about billing for a visit when the doctor doesnt actually see the patient.
Family practice coders should recognize that it is appropriate to charge for nurse-only visits when the visit meets carrier requirements. Typically, the most accurate way to bill for a short nurse-only 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).
For a nurse-only visit, the presenting problems are typically minimal and the normal visit time is only five minutes or so, says Mary Mulholland, BSN, RN, CPC, reimbursement analyst in the Department of Medicine at the Hospital of the University of Pennsylvania in Philadelphia. There are no specific time restraints placed on 99211, she adds, but five-minutes is recognized as the rule of thumb. The actual time spent with the patient may vary according to the needs of the patient. There is no need for a nurse to rush through this type of visit.
Mulholland notes that the nurse might render a range of services including, but not limited to:
vital sign checks;
uncomplicated suture removal, if placed by another physician;
dressing changes;
diet instructions;
review of self-medication administration, including a discussion of possible medication side effects;
rapid strep screening test; and
formal patient education instruction.
For instance, a family practitioner may treat an elderly patient for rheumatoid arthritis (714.0). The patient will likely experience decreased range of motion and some limitation in their activity level. A nurse might review energy conservation methods with the patient to help them perform activities of daily living more efficiently, explains Mulholland.
A nurse also may see a patient who is being monitored following an adjustment of a medication. Perhaps the physician has ordered a lower medication dosage for a patient who suffers from hypothyroidism (244.9). The lab tech would draw the blood and run the lab tests, points out Marilee Phillips, RN, nurse specialist at the offices of David Neustadt, MD, in Louisville, Ky., but I may be called in to answer patients questions, which can be time-consuming. For that, we bill the 99211.
In a case like this, the nurse may also check the patients vital signs and question the patient about any potentially worrisome symptoms such as heart palpitations, weight gain or tiredness.
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