Wiki Texting an MD to ask a question....

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MelDS

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Our clinic is part of a hospital system. We have three Nurse Practitioners and two doctors. One dr. oversees the NPs but is only in the clinic a few times a month because he works in another clinic as well. He has informed our NPs that they can text him any questions and he will answer. He has also told them that if they document this in the chart they can automatically code a 99214/04 or 99215/05 for the visit. This wouldn't be a consult so how is this possible? I am reviewing the guidlines but I am stumped on this one. Any input would be appreciated.
 
MarcusM said:
That would be fraud since the doctor has not performed an eval & mgt billable service.

http://www.stopmedicarefraud.gov/aboutfraud/index.html

What are some examples of Medicare fraud?
A healthcare provider bills Medicare for services you never received.
A supplier bills Medicare for equipment you never got.
Click to expand...

The Nurse Practitioner is still the provider. The dr. is not billing for his services. I guess the dr. is looking at the time it will add to the encounter by conferring by text or phone and then when the NP documents. The amount of time would make it a level 4 or 5.
 
Also, you need to research HIPAA rules when it comes to texting information that may contain PHI.

Since there is no encryption with cell phone text messages, phones may not be locked correctly, and wi-fi is often unsecure...you should NOT be texting PHI using a cell phone.

Imagine the problem you will have if one of those phones is lost or stolen.
 
Okay, the communication with the doctor adds to the complexity of medical decision making since the NP would only communicate on non-routine medical issues. This does not automatically jump the E&M up one level though as you would still need to document the clinical rationale.
 
Texting the MD with PHI would be a HIPAA violation, so I would recommend stopping that practice right away.

You also can't use the time spent texting between the NP and MD as total time for the length of the encounter. Counseling also has to be face-to-face so it can't count towards the counseling time, either.

I know this may come as a shock.... but your doctor is wrong. The idea that texting him "automatically" means they can bill a 99214/04 or 99215/05 would be laughable if it weren't so concerning. I can't imagine the doctor would this rule up entirely -it sounds to me like they got some bad info.
 
MikeEnos said:
Texting the MD with PHI would be a HIPAA violation, so I would recommend stopping that practice right away.

You also can't use the time spent texting between the NP and MD as total time for the length of the encounter. Counseling also has to be face-to-face so it can't count towards the counseling time, either.

I know this may come as a shock.... but your doctor is wrong. The idea that texting him "automatically" means they can bill a 99214/04 or 99215/05 would be laughable if it weren't so concerning. I can't imagine the doctor would this rule up entirely -it sounds to me like they got some bad info.
Click to expand...

After 17 years with this hospital system (the last 2 have been coding) a doctor being wrong comes as no shock to me. From what I have been told, the dr had a meeting with our clinic providers and gave a whole presentation from the 1997 guidelines to let them know many different ways they can code better to get higher E/M levels. I was not invited to the presentation so I don't know all that was presented. I do believe he may be twisting certain parts of the guidelines to say what he wants them to say. I am now spending time combing the guidelines, as well as the E/M guidelines in the CPT, with a fine tooth comb to prepare myself for any discussions with this dr. Any additional advice or link to resources would be much appreciated.
 
I would suspect the doctor has an attorney friend and took a page out of Attorney Billing 101 where EVERYTHING is billable....
 
I'm all for the providers getting together and reviewing the guidelines to compare notes and see if they can code for higher levels of service. In my experience most of the coding errors I come across are undercoding. That said, I was just at a regional MGMA conference in Newport and there are an increasing amount of providers and practices that are being fined for HIPAA violations pertaining to texting patient data on unsecured cellphones, and lost/stolen laptops and thumb drives with unsecured info. It's a serious area of risk. And like I said, the time doesn't count as "counseling" if it is texting between the providers.
 
I made a decision to take my concerns to the practice administrator regarding the texting issue. I was assured that the issue would be looked into and I do trust my administrator to do this. Our hospital system does not want any HIPAA violations and we have a Compliance dept that deals with these types of issues.
 
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