Wiki Can a nurse code higher than 99211?

[Lisa Bledsoe]

So - here I sit with with CPC, CPMA and CEMC certifications...darned if I can find documentation from CMS or any other sourse to support my stance that a nurse cannot code any higher than 99211 for any reason. Please help! I need to locate the written documentation to support my stance!! I have an RN telling me that she "has never heard that you can't bill higher than 99211 for a nursing visit". This is specifically for a wound care clinic where the nurse may do multiple dressing changes, discharge planning (from the wound care clinic, and/or extensive wound care education.
I KNOW that I am right, but of course am being forced to provide documentation to support this...since I am "just a coder" (with extensive experience and multiple credentials)!!!

 

[mitchellde]

If you are billing outpatient facility the rules are different as it is the facility billing and not the nurse and the facility is allowed to bill for utilization of facility resources. If on the other hand this is physician office setting then only the provider may bill using office visit codes. The 99211 is a provider level it is not a nurse level, it is the level of care a provider is allowed to bill when ancillary personnel (ie nurse) is the one face to face with the patient following physician orders from a previous encounter for the same reason. The Provider is required to be within the office suite area while the patient is being seen. If your nurse is an NP then she falls under the definition of provider and may bill any visit level documented. NP, MD,DO, etc these are providers, Nurses , MAs, Techs, etc these are ancillary personnel.

 

[Lisa Bledsoe]

Thanks Debra! The facility is billing a higher level, but for the nurse employed by the physicia for which I am coding, I have told her she cannot submit higher than 99211 (for physician-based billing purposes).