lpiro
Guest
Which code should be used when Billing for Private Duty Nurse Peds to Tricare . Patient is under the age of 21 . Thank you
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Wiki Private Duty Nurse for Pediatrics T1000
- Thread starter lpiro
- Start date
SharonCollachi
Guest
Diagnosis code? Procedure code? What was done? Is the nurse a licensed professional? Are they working under themself or an MD? What is the place of service (I am assuming home, but the question is so broad that I don't want to make assumptions)?
lpiro
Guest
Procedure Code is T1000, Dx G809 private duty nurse when family members are not home . POS is 12 , 12 hour shifts . RN is referred from HHA .
Let me know if you need anything else
Let me know if you need anything else
SharonCollachi
Guest
What are you looking for?
lpiro
Guest
lpiro
Guest
T1000 is a non covered service with payer , I was advised in order for claim to be processed and paid code should be S9123 ???
SharonCollachi
Guest
S9123 Nursing care, in home; by registered nurse, per hour (use for general nursing care only, not to be used when CPT codes 99500-99602 can be used).
99500-99602 are services by non-physicians rendered in the home.
If your payer accepts the S9123, and that's what was performed, and the provider is a licensed RN, then that is what you bill. However, "babysitting", for lack of a better word, is not payable. For the 12 hours to be billed, there needs to be 12 hours of care required by an RN, not just a trained medical person or aide. I do not think I have run across any patients with that diagnosis who required the services of a Registered Nurse 24 hours per day, but of course, it is possible.
99500-99602 are services by non-physicians rendered in the home.
If your payer accepts the S9123, and that's what was performed, and the provider is a licensed RN, then that is what you bill. However, "babysitting", for lack of a better word, is not payable. For the 12 hours to be billed, there needs to be 12 hours of care required by an RN, not just a trained medical person or aide. I do not think I have run across any patients with that diagnosis who required the services of a Registered Nurse 24 hours per day, but of course, it is possible.