Other Qualified Professionals

Debbie C

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Loma Linda- Murrieta Chapter
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Good morning, can someone please help me out with a clear understanding of "who" is actually considered "other qualified professionals"? Who can do counseling with a patient other than an MD, PA, NP?

Is it safe to say a qualified Professional is someone that can write a prescription for meds?

Thanks in advance for your help!!!
 

Pam Brooks

True Blue
Local Chapter Officer
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Hi, Debbie, I've always considered "other qualified professionals" as someone who can be credentialled for payment by the payers, such as MD, DO, APRN, PA. Even then, sometimes mid-levels can provide services, but have to be billed with a supervising physician. Some of the CPT codes are more specific in that they indicate that the service is performed by a non-physician provider. In those cases, we try to determine if the service to be performed is in the scope of their license or certification, such as a registered dietitian or a clinical social worker.
 

rthames052006

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Interesting! I stumbled upon a similar issue on Friday with some verbiage in a carriers policy regarding this.

In what I have for this particular carrier they have a sentence that says:

The initiation of, or changes in, treament should be documented. Treatment includes a wide range of managment options including patient instructions, nursing instructions, therapies, and medications.So we wanted to inquire about the patient instructions that are sometimes given by nurses to patient/family members/parents etc....

I'm still waiting for a firm answer on this one. What happens in the cases where a nurse ie... LPN, RN is providing the counseling.
 

andersee

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Here is an article from SuperCoder:

http://blog.supercoder.com/coding-updates/check-out-who-qualifies-as-‘other-qualified-healthcare-professional’/

RNs and LPNs don't fit in the CPT's new definition.

Many MACS have been confused about who is qualified to administer that vaccination, prolonged service, or neuropsychological testing, and CPT has now decided to clear the clouds of this confusion.

Although, the definition of “other qualified healthcare professional,” has not made a place in CPT 2012 manual, the AMA lists it as part of the “CPT 2012 Errata” on its Web site (www.ama-assn.org/resources/doc/cpt/cpt-2011-corrections.pdf) and the definition is as follows:

“A ‘physician or other qualified health care professional' is an individual who by education, training, licensure/regulation, and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports a professional service. These professionals are distinct from ‘clinical staff.' A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation and facility policy to perform or assist in the performance of a specified professional service. Other policies may also affect who may report specified services.”

Part B practices may be disappointed that RNs and LPNs aren't included in the definition, because it means that CPT will now prevent RNs and LPNs from reporting certain codes that are meant for physicians and “other qualified healthcare professionals” — for instance, immunization administration codes 90460-90461, neuropsychological testing code 96120, cognitive testing code 96125, and prolonged E/M codes 99358-99359.

However, if your payer does not follow CPT rules on this issue, you may still be able to allow an RN or LPN to perform the service, depending on what your insurer states in writing. And remember that state and local laws may specifically dictate who can perform each type of service, so look to your state medical society for information on that as well.
 
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