Nurse visits - documentation from Medicare


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If a patient calls our urology clinic while the MD is in surgery with urinary difficulties we have the patient come in and the nurse performs a minimal exam (99211) along with an ultrasound looking for post void residual (51798). The nurse will insert a foley catheter if appropriate. Assuming we have a verbal order from the MD can we bill for 99211, 51798 & 51702?

If we can bill does anyone have written documentation from Medicare that it is appropriate to bill for these procedures when performed by an RN in the office when the MD is not present?

Thank you very much for your assistance


Richmond, Virginia
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Thin Ice

The 99211 assumes the MD is present. Even if the nurse did only a BP check under a 99211, there is an assumption that the MD had to read the result and make some determination. Actually the MD really should be co-signing the record to show they made some determination. Nurses are not providers and anything they do in office is under the supervising provider (MD, PA, NP).
If you had a NP who was doing this who billed under his or her own number then you could do it, but otherwise no. You cannot bill under a providers number if the provider was not there.
Consideration should also be taken on the risk exposure your practice assumes when you have patients in the building with no provider on site. What if the patient getting that Foley had an arrhythmia? Who would run the code? Who would be responsible? All that comes to mind is:
"Warning Will Robinson, Warning".