Billing for Registered Nurse

[Leesuu]

We have registered nurses performing teaching consults both in person and via telamed for medications, these consults last upwards of 40 minutes. Are we able to bill incident - to for an E/M visit higher than 99211 based on this time?

 

[CBLENNIE]

According to the Medicare only Advanced Practice Nonphysician Practitioners (APNP) are able to bill as incident to a physician and must enroll with Medicare in order to do so, which an RN is not cannot do. They specifically list the following practitioners as eligible to bill as incident to:

• Advanced Practice Registered Nurses (APRNs)
  • Certified Registered Nurse Anesthetists (CRNAs)
  • Nurse Practitioners (NPs)
  • Clinical Nurse Specialists (CNSs)
  • Certified Nurse-Midwives (CNMs)
• Physician Assistants (PAs)

Most commercial payers follow Medicare's guidelines for billing incident to services, so they are also unlikely to reimburse an E&M for services provided by an RN aside from the 99211.

 

[Leesuu]

Thank you for your reply, very helpful!!

 

[Cynthia Hughes]

We have registered nurses performing teaching consults both in person and via telamed for medications, these consults last upwards of 40 minutes. Are we able to bill incident - to for an E/M visit higher than 99211 based on this time?

Just a thought; if the counseling is related to medications treating a chronic illness, the practice may consider whether principal care management codes are an option. This has specific requirements and payers may require patient consent prior to beginning the service so it is preferable to review the CPT guidelines and also payment policies of payers in the area.
Cindy