Wiki RN LED VISITS

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sgrove58

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Green Mountain, IA
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Is anyone familiar with the guidelines for billing out RN Led Visits. My co-workers and I are having a hard time finding any information on the guidelines, and we are seeing these visits done at our Clinics. Any info would help. Thank you so much.
 
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'RN led visit' is a very generic term - are you able to give any more detail about what exactly is being done and/or documented at these visits. The guidelines will depend on what services are being performed. The important thing to remember is that it is outside the scope of the RN license to diagnose or write treatment plans for the care of a patient illness or injury - an RN can only act on the orders of a physician and cannot write their own orders. So most RN services will fall under the 'incident to' guidelines as far as coding and billing is concerned. The main exception to this may be for preventive services.
 
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thomas7331 said:
'RN led visit' is a very generic term - are you able to give any more detail about what exactly is being done and/or documented at these visits. The guidelines will depend on what services are being performed. The important thing to remember is that it is outside the scope of the RN license to diagnose or write treatment plans for the care of a patient illness or injury - an RN can only act on the orders of a physician and cannot write their own orders. So most RN services will fall under the 'incident to' guidelines as far as coding and billing is concerned. The main exception to this may be for preventive services.
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For one clinic site, the RN will do RN Led Visits for the OB history visit. Provider documents it is a RN led visit. Provider signs off on the visit and visits w the patient for a bit. On some of them I have seen where the patient comes in for a BP check and it will be a RN Led Visit, provider signs off on visit. The RN's do not write treatment plans or diagnose the patient.
 
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mgrove58 said:
For one clinic site, the RN will do RN Led Visits for the OB history visit. Provider documents it is a RN led visit. Provider signs off on the visit and visits w the patient for a bit. On some of them I have seen where the patient comes in for a BP check and it will be a RN Led Visit, provider signs off on visit. The RN's do not write treatment plans or diagnose the patient.
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What you're describing here sounds like just E/M services. I think the fact that they're calling it an 'RN led visit' is throwing you off. Also, whether or not the provider 'signs off' on the RN note has no bearing on how services are coded. There really isn't a different way of coding these - the same rules apply here as they would for any other E/M service. In other words, the RN may perform 'incident to' services where they are executing the physician's plan of care under supervision, in which case they may bill a 'nurse visit' CPT code 99211 if those requirements are met. That would be the case in your BP check example, assuming that this was a service ordered by the provider.

In the case of the RN performing a history prior to the provider seeing the patient, that could be billed as an E/M service by the physician, provided that they have documented doing the portion of the work that they are required to do for that visit (e.g. based on level of MDM or time spent by the physician). But the RN's time may not be counted toward the E/M since an RN is not qualified to independently perform a service of a higher level than 99211.
 
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Same sort of question but just need clarification. We do RN led visits at my clinic and one of the providers asked if an RN led visit can be done on a new pt in the cases we need extra help in the clinic when we are short staffed. I said no because this would be considered incident to since the RN is not credentialed. Is this correct or is there a better way to explain this to the providers?
Thanks
 
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