Wiki Incident - to billing

[sroyal1031]

I have a question regarding the final rule and remote supervision as it applies to APP supervision and "incident to" billing practices



42 CFR §410.26



Can someone please clarify if remote audio/visual supervision only applies to nurse level visits E/M code 99211. My administrator feels that we are unable to bill for E/M services provided by an APP with remote supervision using incident to rules for codes 99212-99215

 

[Pam Warren]

Telehealth supervision applies anytime supervision is provided, including teaching physician services, ..... but the E&M code (or any code used) has to report services within the scope of the ancillary staff.

For example, nurse visits are only reportable with 99211, as they cannot perform the level of care represented by a higher E&M code. But you can report 99214 for example, if an APP is billing incident-to an MD, and if all other incident-to guidelines are being met (plan of care, no new patients, no new problems, etc.)

 

[sroyal1031]

Telehealth supervision applies anytime supervision is provided, including teaching physician services, ..... but the E&M code (or any code used) has to report services within the scope of the ancillary staff.

For example, nurse visits are only reportable with 99211, as they cannot perform the level of care represented by a higher E&M code. But you can report 99214 for example, if an APP is billing incident-to an MD, and if all other incident-to guidelines are being met (plan of care, no new patients, no new problems, etc.)

Thank you for your response. So the rules didn’t change for an APP to include virtual supervision for incident-to? The supervising MD still need to be within the office of an APP?

 

[Pam Warren]

The provider performing the supervision can be virtual. The MD doesn't have to be in the office if the APP is providing the virtual supervision for the RN. My comments about scope have to do with the service being provided under virtual supervision in the office setting: an integral part of the care currently being provided under the MD or APP, so no new problems and no new patients. And the services being provided have to be within the scope of the practitioner. So an RN cannot provide an office procedure such as a lesion removal, as surgical services are not within an RN scope.

If the APP is performing the incident-to service, then the MD has to be virtually available. Hope this clarifies.

 

[jkyles]

I have a question regarding the final rule and remote supervision as it applies to APP supervision and "incident to" billing practices



42 CFR §410.26



Can someone please clarify if remote audio/visual supervision only applies to nurse level visits E/M code 99211. My administrator feels that we are unable to bill for E/M services provided by an APP with remote supervision using incident to rules for codes 99212-99215

Share the text of the new direct supervision rule with your administrator. Effective Jan. 1, virtual DS it is an option for all services that do not have a global surgery indicator of 010 or 090. https://www.ecfr.gov/current/title-42/part-410/section-410.26#p-410.26(a)(2)

Direct supervision means, except as provided in paragraphs (a)(2)(i) and (ii) of this section, the level of supervision by the physician (or other practitioner) of auxiliary personnel as defined in § 410.32(b)(3)(ii). The presence of the physician (or other practitioner) required for direct supervision may include virtual presence through audio/video real-time communications technology (excluding audio-only) for services without a 010 or 090 global surgery indicator.

They may be thinking of last year's waiver which restricted virtual DS to 99211 and services with at PC/TC indicator of 5, but the permanent rule replaced that.

The encounter must meet the other requirements for an incident-to service (established patient, the APP or ancillary staff are following a plan of care, the supervising physician is immediately available, etc) and it is a good idea for the supervising provider to document that they determined that virtual DS was appropriate for the encounter.

Also - virtual DS is also an option if the APP is performing a telehealth service. You just have to make sure the APP has the ability to set up a second connection to the supervising provider while still connected to the patient.