Help! Need help with a County Health a department

prusso

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I have been billing (through a billing company) for a county health department for a while now and I just found out that the visits that I am sending out are nurse visits (RN) however they are being sent under the health officer with a regular E/m code not the 99211. Its my understanding that if the physician or np did not see the pt we can not bill out a nurse only e/m visit with anything other then 99211. Im also finding out a qhp isnt even in the building. They say they have a health officer and that is all they need. So that being said, im not familiar with the health department rules and regulations so is there an exception to these rules Im not familiar with. I asked the health dept and All I get is. We can do it this way and that they have done it this way for 18 yrs and they follow their protocols. please please if someone can help me. Ive looked everywhere and cant find any documentation.
 

SharonCollachi

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Is the MD in the building, has the MD evaluated the patient, and is the nurse following an established care plan? In other words, is this an "incident to" situation?
 

prusso

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Is the MD in the building, has the MD evaluated the patient, and is the nurse following an established care plan? In other words, is this an "incident to" situation?
No the MD is not in the clinic, it's possible he is in the building someplace. The MD is not seeing the patient, the RN is seeing the pt. An example would be our STD clinic that has patients come to them for STD screening/bloodwork or treatment of STD's/injections. As my original question is asking, is there some type of exception to the rules of how we bill. I feel the nurse can not bill anything if the physician is not in the clinic/building. I also feel that the only e/m that can be billed if it applies would be 99211 however I am trying to discover any information I can to make sure that there are no exceptions to the rules for county health clinics or maybe even STD clinics or family planning clinics. I have searched high and low and I don't know where to turn.
 

haraml7

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The Health Department Rules would not be any different. An E/M visit would not be appropriate and "incident to rules" would need to follow for E/M codes. If the provider was not in the office or in the building for general supervision for a procedure, or evaluation and/or orders, an E/M would not be appropriate.
Oh boy, the "we have always done it this way" saying! The rules and regulations are always changing in Medical Billing and Coding so "always" doing something one way in medical billing is a scary thought.
My first question is, does the RN have their own NPI number and credentialed? NP, ARNP?
Also, if just a UA was performed, or blood was taken and sent off to a lab an E/M code would NOT be appropriate and these can be billed without the presence of physician. The description in our CPT book for an injection states that a MD supervision is necessary.

I would double check the RNs credentials, and then go from there. if she is just screening STDs, like from a urinalysis, the urinalysis alone can be billed by itself there is no reason to bill a 99211.
 
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