Nurse only visits

dmckeon

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I have seen documentation for nurse only visits where a patient is seen for a sick visit by the Registered Nurse only. The nurse takes vitals, does brief exam, may do rapid strep and/or rapid influenza if appropriate. The nurse then "concurs" with the physician or nurse practitioner who may issue prescription for meds if appropriate; if no prescription issued directive to continue with home care, increased fluids and rest, etc. to patient. I have coded these visits as Non-billable encounters since the physician did not order the services and Incident To requirements have not been met and claims have been adjusted off. However; there are those in clinic that feel these visits should be billable because the Nurse concurred with the provider. There is no separate documentation from the physician/NP. Can someone point me in the direction of where I can find that "Sick" visits by a nurse only do not constitute Incident To service to back me up??? Any help would be appreciated.
 

thomas7331

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I think the answer to your question is in the 'incident to' guidelines. As a practical matter, if 'incident to' requirements are not met, there is no way to bill these services. Payers will not credential a RN as a provider and so without meeting 'incident to', you don't have a provider name or number that you can legally put on the claim form to submit.

In what way are they not meeting 'incident to' in this situation? As you describe it, it almost sounds like they are asking the RN to practice outside the scope of their license if they are having them diagnose and treat patients independently.
 

dmckeon

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Thomas in reply to your question, I don't think Incident To is being met because according to the Incident To guidelines the nurse visit is supposed to be a part of the established treatment plan by the provider and service ordered by the provider to see nurse. In this instance I do not believe that a "sick" visit on the RN schedule for possible URI, cough, cold, meets Incident To and is unbillable. Even though the nurse states "conferred with provider" after taking chief complaint, vitals and brief exam how does that meet Incident To?
 

thomas7331

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I agree with you on that - if the patient is presenting with a new problem and the provider hasn't outlined a plan of care or orders that the nurse can follow, this can't be billed 'incident to'. This might be easily be solved if the provider would just take a few minutes to step inside the room and do the 'conferring' portion of it as a face to face with the patient, and document it with a brief note.
 
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