Wiki 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.
 
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?
 
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.
 
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.
 
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.
Hi there! So what is the cpt code for billing lab only if not seen by NP?
 
So a uranalysis is 81003 (make sure to check CLIA). blood draw is 36415. If the Health officer is an MD and in the building to provide "general supervision" its OK to bill for injections like testosterone shots, or depo. and if the office is providing the medicine you would bill the medication code. If the patient brought their own medication you do not bill for the medication (testosterone medicine for example)
 
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.
Thank you for your response. I agree with everything you are saying. The NPs are credentialled however their RN's do not have an NPI/credentialling. I have addressed these topics with the head of the billing department at the health department and so far I have rec'd nothing but excuses and reasons. They are very unfriendly when questioned. I work for a billing company so I don't work directly for them. I am just not sure how I am actually supposed to fix this. Well, I will continue to try to figure this out. Again Thank you for your help!
 
Hi there! So what is the cpt code for billing lab only if not seen by NP?
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.
question, your reply separated the UA and venipuncture from the injection code. Are you meaning the physician has to physically be in the room during the injection? I have always thought that both UA/Veni and the injections would require the physician to be available in the suite for direct supervision to bill out to insurance. When you say the UA and veni do not require the presence of the physician that kinda threw me off. Could I get clarification of what that means or what the difference of billing them would be?
 
question, your reply separated the UA and venipuncture from the injection code. Are you meaning the physician has to physically be in the room during the injection? I have always thought that both UA/Veni and the injections would require the physician to be available in the suite for direct supervision to bill out to insurance. When you say the UA and veni do not require the presence of the physician that kinda threw me off. Could I get clarification of what that means or what the difference of billing them would be?
Thank you!!!
 
question, your reply separated the UA and venipuncture from the injection code. Are you meaning the physician has to physically be in the room during the injection? I have always thought that both UA/Veni and the injections would require the physician to be available in the suite for direct supervision to bill out to insurance. When you say the UA and veni do not require the presence of the physician that kinda threw me off. Could I get clarification of what that means or what the difference of billing them would be?
Sorry about the confusion,

For an injection (not venipuncture) the injection is in the muscle, a veni is less "invasive" per say. So the provider does not need to be in the same room with an injection, just in the "area/building" or "facility/suite" to provide help if needed. Direct supervision is different then general supervision.

A uranalysis does not need the physician present, a venipuncture does not need the physician present you would just bill for the uranalysis, there is not an evaluation when doing an urinalysis, the provider I assume, ordered it and the patient goes to the lab area for the UA, so the nurse just collects the specimen. the same goes for the blood draw/or venipuncture.

I hope this helps, don't hesitate to reach out if you need more information. :)
 
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