Wiki Nursing Procedures

KaylaRieken

True Blue
Messages
504
Location
Waukee, IA
Best answers
0
My physicians are asking me when nursing procedures are done and there is no provider in the office, can it be billed under a provider's name? For example, if a patient comes in for an injection or a catheter exchange, can it be billed under their name if there is no supervising physician?

I have always thought that a supervising physician had to be within the four walls. If no one is there, what happens then? I understand Medicare and incident to, but what about commercial plans? Anything in writing that I could forward to my physicians regarding this would be greatly appreciated.
 
For physician offices that are not hospital based, you are correct - the 'incident to' rules must be met in order for any service to be a covered benefit under government plans. I believe there are some specific exceptions for immunizations, but not much else. (Hospital based locations have some additional flexibility in that there is a limited list of services which nurses may perform under 'general' supervision which does not require that the physician be on site.)

Commercial plans, however, can create their own policies as they wish, or may also specify in their contracts what they require. You would really need to contact each plan to find this out. But rather than do this, I would ask the physicians if they would really want to allow nurses to perform procedures unsupervised for just patients with certain types of insurance - that makes no sense to me. And what if you found out after the fact that a patient you thought was a commercial patient actually turned out to be a Medicare patient?

Another thing to consider is what your state regulations and terms of your malpractice insurance require in the way of supervision for nurses. The physicians could be putting the nurses at risk of being in violation of their license requirements and/or scope of practice laws by doing this, and the practice owners could be putting themselves in the position of invalidating their malpractice insurance.

Given all this, I think the practice of leaving nurses to perform services unsupervised in the office setting would be a very risk one, and would recommend you defer this to the physician's lawyers for guidance - this is really outside the scope of coding responsibilities.
 
Last edited:
Top