Wiki 98960

[ajoyner@nashobgyn.com]

If a Registered Nurse is performing a "Diabetic Education" class for obstetrical patients, can 98960 be billed? Has anyone billed this code, for this reason? Are there any specific requirements or certifications that the RN is "required" to have, per insurance?
For a while now, our office has billed 0502F ($0) charge because we were "told" (not sure by whom or their role) that we can't bill unless the Provider has a certification or a registered dietitian provides this class. Any insight/help would be great!
Sincerely, A girl just trying to help our practice grow

 

[jkyles]

Hi there, the "nonphysician qualified health care professional" in the descriptor means a QHP who can't report E/M services, but who can bill the service under their own name/ID. That's controlled by state scope of practice, but I've never heard of RNs being able to independently bill for services (unless you're talking about an APRN like an NP).

 

[ajoyner@nashobgyn.com]

Hi there, the "nonphysician qualified health care professional" in the descriptor means a QHP who can't report E/M services, but who can bill the service under their own name/ID. That's controlled by state scope of practice, but I've never heard of RNs being able to independently bill for services (unless you're talking about an APRN like an NP).

That is where I am getting confused. I have seen other forums stating that this can NOT be billed or associated under an NP.

 

[csperoni]

When you state "class" do you mean a group setting, or a one-on-one education? If individual, I still don't think it meets 98960 for the reason above by @jklyles. The RN cannot bill independently for the service. If performed by RD, NP, PA, 98960 would seem appropriate.
I also recommend checking with your payors, and your payor policy and contract could change what is appropriate to code.