Wiki Billing for APRNs and PMHNPs

[Nstatley17]

Hello! We have a LCSW who wants to hire a APRN or PMHNP to prescribe medications and conduct some testing. This may be a rookie question but can APRNs or PMHNPs bill E/M codes? From what I am seeing, APRNs cannot and PMHNP can. Additionally, the LCSW is hoping that one of these specialties can bill code 99366 for case management, can either of them do this? I'm having a hard time finding clear guidelines. Also, does anyone have a great resource for figuring out who is considered a midlevel provider or who is considered a NPP or an NP? TIA!

 

[CBLENNIE]

I'm only responding to your question regarding 99366 which you've referred to as case management services. This code is not for case management services, it is for a medical team conference. The following long description from Encoder Pro explains the very specific requirements for billing 99366:

A medical team conference is defined as a service where at least three qualified health care professionals from different specialties or disciplines, each of whom provides direct care to the patient, actively engage in the evolution, revision, coordination, and implementation of health care services needed by the patient. The conferences may or may not involve the presence of the patient, family members, community agencies, surrogate decision makers/legal guardians, and/or caregivers. Medical team clinicians should report the time spent in a team conference with the patient and/or family present with the appropriate E/M code, using time as a key controlling factor for selecting a code when counseling and/or coordination of care dominates the service. The individual clinician must be directly involved with rendering face-to-face services outside of the conference visit with other clinicians or agencies. All medical professionals participating on the medical team must document their own individual participation in the team conference, in addition to their contributed information and follow-up treatment recommendations. However, only one individual from the same specialty may report a code from this category at the same encounter. No individuals may report a code from range 99366-99368 if participation in the medical team conference is a part of a facility or organizational service contractually provided by the facility or organization. Team conferences commence upon review of the individual patient case and conclude once the review has come to a conclusion. Record keeping and report generation time is not reportable. The clinician must report all time for which he or she was present. Reportable time is not limited to the time that the clinician is communicating with other team members, the patient, and/or the patient's family.​

 

[csperoni]

Some of this falls under scope of practice, which can vary state to state. Your question is not only about billing/coding but also legal and compliance. I would recommend obtaining official guidance from a consulting expert after doing your own research if it is not black and white. That being said, here are some of my experiences.
Most states allow NPs to practice independently and prescribe medications. "Testing" depends on the test. For example, NPs may not take x-rays, but they may read x-rays. NPs may perform and bill for E&M services. It is rare nowadays, but you may find an insurance or 2 that will not credential NPs.
The term APRN can be vague and is comprised of several different types of advanced practice nurses. NPs are one type of APRN. Other examples are CNM (midwives), CRNA (nurse anethetists) and CNS (clincal nurse specialists). What one APRN is allowed to do for scope of practice and billing can vary greatly based on the type of APRN. From my limited experience with CNS in my state, they cannot practice independently and there is little more they can do than an RN. I would imagine for the services you are looking for, CNM or CRNA are not relevant.
For states that require a collaborative supervisory agreement for NP or other CNS, an LCSW would not qualify.