Wiki 99421 billing

[mwells2020]

One of our Dr's has an established patient who's Mother contacted our Dr's nurse about her daughter having pink eye. The nurse contacted the Dr, who was not in the clinic that day, and the Mother sent a picture of her daughter's eye to the Dr and he prescribed an antibiotic after viewing the picture. Will it be ok to bill a 99421 in this instance? The Dr did not talk to the mother or daughter. Just needing help in how to bill this or if I can bill this. Thank you in advance!

 

[jkyles]

Hi there, could you clarify how the Mother contacted the nurse and how she sent the picture to the doctor?

 

[mwells2020]

I talked with the nurse and she couldn't remember whether the Mom emailed her or left her a voicemail. The picture was sent from the Mom to the Dr. by phone or email. The Dr. isn't in today to confirm which one.

 

[jkyles]

I talked with the nurse and she couldn't remember whether the Mom emailed her or left her a voicemail. The picture was sent from the Mom to the Dr. by phone or email. The Dr. isn't in today to confirm which one.

OK, thanks. You'll need to exclude the contact to the nurse. There's no way to tell if the initial contact was through a HIPAA compliant, digital platform. Plus - based on a CPT Assistant article - the expectation is the initial contact would go directly to the treating physician/QHP, not from clinical staff (whose time can't be counted) to the treating practitioner.

For the contact from Mother to physician, if it was HIPAA compliant and the doctor's documented work based on the Mother's contact alone - not information from the nurse - meets the codes' requirements, you could bill that.

 

[mwells2020]

Thank you so much for your help! It is greatly appreciated.