Wiki Nurse Case Manager visits

[aekenyon87]

Our coders have been billing unlisted code 99499 for a Work Comp nurse case manager visit, but now a provider is questioning whether or not there is another code that would be more appropriate. The provider is speaking to the nurse with the patient present immediately after the patient is evaluated by the provider. Is there another code that would be more appropriate for this situation? The provider is located in Wisconsin. Thank you.

 

[NRaizman]

I have never seen anyone bill separetly for these.
I guess you could count it as an independent historian for E&M purposes if you wanted.
If you're getting paid for 99499, it's reasonable.

 

[Pam Warren]

Actually, there is.

Medicare has codes to be used to report nurse navigator services for principal illness care, such as Cancer, or pulmonary disease. G0023 and G0024 are used to report this monthly, based on time. There is a pretty significant list of criteria, including supervision, documentation expectation and nurse navigator involvement. CMS has published this criteria. Commercial payers may accept these codes, but you will have to check.

I will be presenting on this and other chronic care models at HealthCon Regional, Seattle in October.

 

[NRaizman]

Actually, there is.

Medicare has codes to be used to report nurse navigator services for principal illness care, such as Cancer, or pulmonary disease. G0023 and G0024 are used to report this monthly, based on time. There is a pretty significant list of criteria, including supervision, documentation expectation and nurse navigator involvement. CMS has published this criteria. Commercial payers may accept these codes, but you will have to check.

I will be presenting on this and other chronic care models at HealthCon Regional, Seattle in October.

Pam - these codes are used for the navigator's services, not for the provider's talking to the nurse navigator, right? I think the poster's question is whether the physician can bill for talking to the nurse case manager, which would not be covered by these G-codes.
N.

 

[Pam Warren]

hmm... I thought the question was with regard to the nurse case manager visit. "Our coders have been billing unlisted code 99499 for a Work Comp nurse case manager visit", Besides, wouldn't the MD visit discussion with the nurse apply to 'data' in the E&M visit? Maybe the OP can clarify.

 

[aekenyon87]

Here is an example of the provider's dictation.

 

[NRaizman]

That confirms that it is the provider attempting to bill for a conference with a NCM, not the other way around.
Cannot use the G codes that Pam had suggested, as they would be for the NCM to bill, not for the doc.
N.