Question Pharmacist Options - CHC

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Citrus Heights, CA
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I work for an FQHC/CHC and they are trying to catch missed revenue. I know a Pharmacist only encounter is 99211 (nonbillable in our setting). However, if they implement a process where the Pharmacist initiates the visit like a RN would and then leaves the MDM to the provider for completion, would this qualify as a provider visit with those coding guidelines instead?

Note: not loving the idea but need to know if this is an option within the supervising physician format.
 

Kristen Bensel

Networker
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Unless the provider is actually examining the patient themselves during the encounter, leaving the MDM for the provider to finish wouldn't be appropriate.

I work for a Tribal Clinic (similar to the FQHC) and we use pharmacists for chronic care management, anti-coagulation visits and a few other ancillary staff tasks, and bill the 99211 under incident to guidelines. However, I am not familiar with California licensing for a pharmacist to know what they are allowed to do to stay in their scope of practice.

Hope that helps some. :)
 
Messages
5
Location
Citrus Heights, CA
Best answers
0
Unless the provider is actually examining the patient themselves during the encounter, leaving the MDM for the provider to finish wouldn't be appropriate.

I work for a Tribal Clinic (similar to the FQHC) and we use pharmacists for chronic care management, anti-coagulation visits and a few other ancillary staff tasks, and bill the 99211 under incident to guidelines. However, I am not familiar with California licensing for a pharmacist to know what they are allowed to do to stay in their scope of practice.

Hope that helps some. :)
Thank you Kristen. I appreciate the input.
 

thomas7331

True Blue
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From what I've read, North Carolina is the only state that allows (or is considering allowing - I'm not sure if it was actually implemented) pharmacists to perform and bill E&M services, and that is with a special license and only under limited circumstances. A pharmacist can only bill 99211 if working 'incident to' a physician's plan of care - which means carrying out a physician's order while supervised and employed by that same physician. If the pharmacist is 'initiating' the visit then that, by definition, is not 'incident to' because the physician would have had to order the visit and its services in the first place in order to qualify as such.
 

Kristen Bensel

Networker
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33
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Agreed Thomas. Although, it is completely in the pharmacists scope to provide E/M of a higher degree, payers are still not recognizing them as such. I have heard that Washington may also allow them to bill on their own at a higher level also.

What are your thoughts on if a pharmacist performs smoking cessation counseling at the request of the provider on the same day they see the patient. The pharmacist does 8 minutes of counseling, (well with in their scope of practice). But since they aren't considered a billable provider type: Would you bill the E/M appropriate for the provider visit, with the 99406 to reflect the services done incident to the provider? Or just the provider visit.
 
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