Wiki Billing procedures by RN

Karajag

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Hello! I am looking for assistance in regards to billing for procedures performed by a nurse (RN) in office. I recently started coding for OBGYN and there have been quite a few questions popping up as to whether they are billing out their charges correctly. Unfortunately they have never questioned what was being sent out previously.

The issue currently is whether an RN can perform a straight cath in office for a clean urine sample. They do a dipstick test in the office after collection, and they use their own supplies. The provider who requested it is not on the premises the day this is performed. Can this charge (51701) be billed? The other coder has conflicting thoughts about this and I could use some guidance as they are now trying to determine if they are billing out other nurse-performed services (i.e. Urine HCG’s, Venipuncture, Fetal Non-Stress Tests (NST’s), Injections) correctly! If the 51701 is not able to be billed out would it be billed as 99211 with 81002? Thanks in advance!
 
If this is an office practice, the procedures done by an RN may be billed if they are within the scope of the RN's license and they meet all of the 'incident to' requirements. One of those requirements is that the procedure be supervised on-site by the physician who employs the RN and under whose credentials this is being billed. So if that physician is not in the office, it would be inappropriate to bill those services as they would be considered non-covered under Medicare and some other payer guidelines. I don't know that it necessarily needs to be the same physician who requested the service, but some physician acting in a supervisory capacity needs to be there in order for this to be allowed.
 
Thank you Thomas! This is exactly the clarification I needed. I greatly appreciate the quick response!
 
If this is an office practice, the procedures done by an RN may be billed if they are within the scope of the RN's license and they meet all of the 'incident to' requirements. One of those requirements is that the procedure be supervised on-site by the physician who employs the RN and under whose credentials this is being billed. So if that physician is not in the office, it would be inappropriate to bill those services as they would be considered non-covered under Medicare and some other payer guidelines. I don't know that it necessarily needs to be the same physician who requested the service, but some physician acting in a supervisory capacity needs to be there in order for this to be allowed.
Thomas would you know where i can find these guidelines that state the supervising provider needs to be there I am having a similar issue and they want proof to show where it states that a provider needs to be present
 
Thomas would you know where i can find these guidelines that state the supervising provider needs to be there I am having a similar issue and they want proof to show where it states that a provider needs to be present
I responded to your question on your other thread which should cover this, but let me know if I can help further. Really it's not your job to 'prove' anything to the provider - if you're a coder, you aren't being paid to do a lawyer's job. It's a legal and compliance question - a coder can advise and recommend, but providers really should be running this kind of thing by their practice's attorney before making any final decisions of this sort.
 
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