monster805
Guest
When a nurse uses code 99211, does it require a doctor to cosign?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Provider Cosign for Code 99211
- Thread starter monster805
- Start date
pinnaclephyserv
Networker
I would like to know if you ever got an answer for this?
thomas7331
Guest
There's no coding guideline that says a provider must cosign a nurse's notes. Some practices may require it as a matter of internal policy though, and it's possible that some state laws or license requirements may stipulate something to this effect, although I've never encountered this. The physician's signature does record that the physician reviewed and acknowledged that the service was performed, which a good documentation practice, even if not a requirement.
From a coding perspective, the 'incident to' guidelines require that the services the nurse performed were ordered by the physician as an integral part of the plan of care for the patient, so the order or plan for this nurse visit must have been documented by the physician. But there's no coding requirement that the physician must have also signed the note.
From a coding perspective, the 'incident to' guidelines require that the services the nurse performed were ordered by the physician as an integral part of the plan of care for the patient, so the order or plan for this nurse visit must have been documented by the physician. But there's no coding requirement that the physician must have also signed the note.
Last edited:
Interestingly, I believed the same as @thomas7331 that an RN note did not REQUIRE physician signature unless it's an internal policy or state requirement (but still a good idea). However, I just came across documentation today from Palmetto MAC (while researching something else) that to bill incident-to performed by ancillary staff, it must be signed by the supervising/billing provider.
amyjph
True Blue
Interesting. I thought the same thing as well.
I also found this which conflicts when talking about immunizations: https://med.noridianmedicare.com/web/jfb/cert-reviews/signature-requirement-q-a
Q15. Do late signatures also apply to orders for immunizations (TDAP, PPD, etc.)? The Registered Nurse (RN) signature is included but still need the provider's signature.
A15. The ordering provider is not required to sign the record entry by the RN, but medical documentation must support the ordering provider is overseeing the patient's care as well as a signed order for the services performed by the RN.
I think it's a very good idea that it be internal policy even if there is no 100% clear guidance on it. And, I agree as above, state laws would have to be checked.
I also found this which conflicts when talking about immunizations: https://med.noridianmedicare.com/web/jfb/cert-reviews/signature-requirement-q-a
Q15. Do late signatures also apply to orders for immunizations (TDAP, PPD, etc.)? The Registered Nurse (RN) signature is included but still need the provider's signature.
A15. The ordering provider is not required to sign the record entry by the RN, but medical documentation must support the ordering provider is overseeing the patient's care as well as a signed order for the services performed by the RN.
I think it's a very good idea that it be internal policy even if there is no 100% clear guidance on it. And, I agree as above, state laws would have to be checked.
lgardner
Guest
Very interesting.
I, also, thought that it wasn't a requirement, but that it was best practice.
I have, always, had providers sign off on ancillary notes.
I, also, thought that it wasn't a requirement, but that it was best practice.
I have, always, had providers sign off on ancillary notes.