Wiki Public Health Clinic billing question

[DEBI MCLAUGHLIN]

Hi. I am currently billing at a public health clinic and have a question. There are no doctors on staff here, it's only nurses and several clinics. I know I can bill a 99211 when seen by an APRN, but what about other nurses? We have RNs and BSNs also here. Can an APRN bill a higher level than 99211 if the visit warrants it? Just came a from specialty practice coding where patients were seen by the physician only and I am the only coder on staff here as their billing dept. is pretty new and I have no one to ask. The CPT book is unclear. Also sometimes I see codes 99395 or 99396 in the family planning clinic, same question there, can I only bill when an APRN does the exam or any nurse when an APRN is on staff at that clinic?

I know this is a lot. Thanks in advance for your help!

 

[Chelle-Lynn]

There are 4 types of APRN...Which one is being used in your clinic?

• Nurse Practitioners (NP)
• Clinical Nurse Specialists (CNS)
• Certified Nurse-midwives (CNM)
• Certified Nurse Anesthetists (CNA)

 

[DEBI MCLAUGHLIN]

The first two probably. their credentials on the electronic records just read APRN.

 

[thomas7331]

An APRN can practice independently (at least in the states I've worked in), so their services can be billed the same as if they were a physician - they can use any of the E&M code levels, assuming the documentation supports it. RN and BSN services can only be billed if they meet the 'incident to' requirements - in other words, services that were ordered by and are an incidental part of a physician or NPP's plan of care and which are appropriately supervised. 99211 is the only E&M code they can bill because it is the only E&M service that does not require a face-to-face encounter with the provider, however the other 'incident to' requirements still must be met.

 

[DEBI MCLAUGHLIN]

Thank you!