Billing Nurse Case Manager

bellsmom

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hi, need some help... i work for a very ortho office and need some codes i may use to bill the work comp ins. We see nurse case managers and the code we are using to bill the ins for the visit is being denied. If anyone is billing for the visit of a nurse case manager that is seen after the patient, on the same day. Can you please give me some CPT codes??? We are lossing alot of money and need some HELP.. :confused:
 

mitchellde

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What codes are you using? What service is provide? Are you saying these are occuring on the same day as the physician encounter? Is this post op or post fracture care?
 

bellsmom

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yes the patient is seen on the same day but the nurse goes in after the patient is seen, it can be anything from consult to fracture care to post op. We are billing either a visit for the patient then billing for the nurse case manager. The code we are using for the nurse case manager is 99367, but they are no longer accepting this code. We have called several compan. to ask what they want us to bill but they won't give out the codes.
 

MMadrigal

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Nurse Case Manager

yes the patient is seen on the same day but the nurse goes in after the patient is seen, it can be anything from consult to fracture care to post op. We are billing either a visit for the patient then billing for the nurse case manager. The code we are using for the nurse case manager is 99367, but they are no longer accepting this code. We have called several compan. to ask what they want us to bill but they won't give out the codes.
Anytime the Case Managers use doctors time, especially outside the presence of the patient, we collect up front. We educate them prior to the visit, so they are all prepared with they check of debit card. We provide a reciept that they can submit with their report, for reimbursement. It works perfect. We were sick of having the IA companies deny our claim as "not a medicare valid code". Mary
 

cwilson3333

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nurse case manager visits

We, too, require advance payment for the nurse case manager visits. And usually we make sure the patient is okay with the NCM being in on the same visit. If not, then we book a separate time for the patient, and follow-up time for the NCM.

CPT 99367 is the code I use for their visit.
 

orthobiller2000

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I use RN001 for case managers for workcomp and auto claims and have no problem getting paid $25.00 from the carrier, regular health insurances willl not acknowledge RN001. Not sure if your local comp/auto will accept this code, but they do in Michigan. Hope that helps.
 

mitchellde

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99367 is a code for an interdiscipilinary team conference without the patient present. You cannot use this code for a Nurse case manager to see the patient, even if you collect up front. The nurse in a physician office is an ancillary personnel and as such her services are non chargeable when performed with the physician visit, the same as you do not charge for the nurse to take vital signs. If this is prior to surgery it is preop and is part of the surgery , if it is post op it is part of the surgery, same thing with fracture care when the physician performs a global service then all persons in the office are under the global for service related to that procedure.
I do not see anything separately billable in what you have described the nurse as doing.
 

bellsmom

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Thanks everyone for the feed back...

To mitchellde: the doctor see the patient and they leave, then the nurse case manager is seen by the doctor and we need a code for that visit
 

mitchellde

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Sorry I am not seeing this as a billable service. It is not case management it is not team conferencing. It is the nurse giving the patient instructions about their expectations etc. this is not billable on the same day the physician sees the patient, it is considered part of the encounter, and is definitely part of any surgical global. It is no different than a nurse in a surgeons office giving preop or post op instructions and that is not billable. If the nurse is providing education for the patient self management then go to 98960 for this. This is a nonphysician code and may suite your needs.
 

MMadrigal

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Sorry I am not seeing this as a billable service. It is not case management it is not team conferencing. It is the nurse giving the patient instructions about their expectations etc. this is not billable on the same day the physician sees the patient, it is considered part of the encounter, and is definitely part of any surgical global. It is no different than a nurse in a surgeons office giving preop or post op instructions and that is not billable. If the nurse is providing education for the patient self management then go to 98960 for this. This is a nonphysician code and may suite your needs.
Michelle, the nurse case manager represents the insurance company's interest, not the doctors, if she uses doctors time, he can charge for it. (They are involved to keep things moving along, as quickly as possible). You can create your own internal code for bookkeeping purposes, and we charge alot more than $25.00. Mary
 

mitchellde

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Please give me a reference for this, as physician level are billable only for physician face to face time. If you are speaking of work comp this is different. If the nurse case manager represents the insurance companys interest then why are you collecting from the patient up front. If I were the patient I would refuse to pay for it. I have worked ortho for several years and this was never done. In the facility setting we had case managers but that was completely different. So if the insurance company is requiring a nurse case manager to protect their interest then they must pay for it.
 

MMadrigal

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Nurse Case Manager

Please give me a reference for this, as physician level are billable only for physician face to face time. If you are speaking of work comp this is different. If the nurse case manager represents the insurance companys interest then why are you collecting from the patient up front. If I were the patient I would refuse to pay for it. I have worked ortho for several years and this was never done. In the facility setting we had case managers but that was completely different. So if the insurance company is requiring a nurse case manager to protect their interest then they must pay for it.
The original poster was talking specifically about work comp. I got the impression you were thinking she was talking about her docs nurse, in the office. The Nurse Case Managers are being reimbursed by the Work Comp Carrier. No monies are being collected from the patient. With the patients permission, and doctors consent, the nurse case managers can be present in the room, and there is no charge on our part, unless she starts consuming our docs time. Then we start billing. Also, as a plus for our doc, other than documenting having met with the NCM, he does not have to submit a detailed report.
Oops Debra, I was calling you Michelle, sorry. Mary
 
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mitchellde

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LOL Most people call me either Michelle or Barbara I know not why! I did miss the work comp in the original post, my apologies. In that case it does depend on what state you are in. Work comp is very different state to state. I have been successful in the states I bill work comp in getting the provider instructions off the net. This will tell you how to bill for them and what codes to use for what services. Since they are not a HIPAA entity they play by their own rules.
 

MercedesHM7

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Nurse Case Manager Billing

I'd also love some insight into if I can bill for a Nurse Care Manager. I work in a GI Specialty office and we are getting a Nurse Care Manger to handle things like patient phone calls to educate and advise during illness. Is this billable at all or is this more along the lines of triage? Any information and/or advise is welcome!

Thanks
 

pampered1

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The practice charges NCM like they are self pay patient - they bill insurance

This is certainly not an ancillary charge. They are not working under the physicians scope of practice, they are working for the insurance company/patient. The NCM will bill the insurance and they receive up to $725 for this service so YES YOU DO bill and collect at time of service for this service you are assisting them with. Otherwise they can wait until you file a copy of your visit to the insurance and review it. Here is a link showing you how the NCM bills it to the insurance but for the provider (physician or NP, YOU COLLECT AT TOS) https://www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2016/MARFS/2016PDFs/Chapter20.pdf
 
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At our office we check with patient if they want the nurse case manager in the room with them or see separately. Either way, we charge $50.00 straight from the nurse case manager and bill with a 99075 just to add to system. We do not bill the worker's comp company, only the nurse case manager. The only time I do any different is if the nurse case manager requests an invoice prior to visit. Otherwise, we run their card, check or whatever and give a receipt for her to reclaim her cost.
 
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