Telephone E/M, Who is considered qualified health care professional

[dmurphy.cva@gmail.com]

We have a situation in my office that I am needing help with (especially with documentation to back up the findings).
In the codes 99441-99443, who is considered other qualified health care professional?
So, here's the situation. We have several patients on Coumadin. The patients go to a lab to have the test done, then our providers manage their medication based on the results. The provider's RN is the one that calls the patient to explain any changes to the medication with the patient.
Can we bill these visits if the nurse makes the call and the provider is overseeing what is happening and signing off on everything?
Please advise!
Thanks.
Daphne Murphy

 

[mhstrauss]

We have a situation in my office that I am needing help with (especially with documentation to back up the findings).
In the codes 99441-99443, who is considered other qualified health care professional?
So, here's the situation. We have several patients on Coumadin. The patients go to a lab to have the test done, then our providers manage their medication based on the results. The provider's RN is the one that calls the patient to explain any changes to the medication with the patient.
Can we bill these visits if the nurse makes the call and the provider is overseeing what is happening and signing off on everything?
Please advise!
Thanks.
Daphne Murphy

I'm not completely confident on my answer about who would be considered a "qualified health care professional", but my opionion would be a physician, nurse practitioner, physician assistant, psychologist...any provider that has E/M billing rights. An RN wouldn't fall into that category.

The other issue to consider, though, is the instructions for this code set. They specifically state that the telephone service must be initiated by the patient (so the RN calling the patient would void this), and the telephone service must not refer to an E/M service that took place within the previous seven days. So if the patient came to the office for routine follow-up care, the doc ordered labs, then your office received the lab results, then called the patient, all within the seven days following the visit, that scenario wouldn't qualify either. Not sure if that is how this is happening, just an example.

My opinion is that the follow-up call to adjust meds would be considered routine care...just my 2 cents...

Hope this helps!


I forgot to mention this...what about Anti-Coag Management Services? Codes 99363-99364? Would that be more appropriate for managing Coumadin patients?