Wiki What Type of Nurse (MA) visits qualify as Incident To Requiring Direct Supervision

[mpisaniello]

PLEASE TAKE THE TIME TO ASSIST!!!! I will be so appreciative!!!!!We have MD's and Nurses ( MA or LPN's). I am having a problem finding a list of services that qualify as Incident To requiring that Direct Supervision must occur from a MD Physically Present in the building while the Nurse Visit Occurs. I am looking for 3 things. Are the Incident To and Non Incident To Examples below correct and where is it determined code by code if direct Supervision is required qualifying that service for Incident To Guidelines? So if someone says does PPD fall under Incident To - Where would we check? I am trying to encourage using resources rather than memorizing because we know that hour to hour something things can change in this new world.

Examples I believe require qualifies as Incident To:

93672
99211

Examples of nurse (MA) services that I believe do not not qualify Incident To:

• Lab draw only visits - Does Not Qualify Incident To - Does not require Direct Supervision therefore the claim can be filled under the nurses assigned MD whether he is inhouse or not at the time of the visit?

• Imunization only visits - Does Not Qualify Incident To - Does not require Direct Supervision therefore the claim can be filled under the nurses assigned MD whether he is inhouse or not at the time of the visit?

• 86580 PPD - Does Not Qualify Incident To - Does not require Direct Supervision therefore the claim can be filled under the nurses assigned MD whether he is inhouse or not at the time of the visit?
  
  
  We want to make sure we are utilizing the flexability of certain nurse visits where the MD that the claim is filled under does not necessarily have to be in the building. For Example if they are on hospital rounds and we want to make sure that the services their assisgned nurse performed in their absense get reinbursed untheir name rather than a supervising MD in the office. I tracked the clarification to a simple standard. There are three types of supervision:
  
  1. General - Not necessary to be in the building during the time of service
  2. Personal: MD performed service himself
  3. Direct: supervising md in the building where services were rendered by the nurse
     
     
     Incident TO is for Direct Supervision only. I thought I had found a cut and dry rull of thumb with the medicare fee schedule that has a collumn for Supervision Indicators. Problem is it is only for Labs ( Diagnostics ) How can their not be a way to see which services are tagged as requiring Direct Supervision?
     
     Thank you in Advance!!!!

 

[CatchTheWind]

I can confirm that 93672 and 99211 require a physician to be present in order to bill incident to. I'm sorry that I do not know the answer as to whether lab draws, immunization, and PPD can be billed if a doctor is not present, but I hope someone else on the forum does. (If you don't get an answer, I would suggest re-posting on the IM or peds forum, as these practices would be familiar with those services.)

What I do want to comment on is to caution you about the use of the term "nurse" when referring to MAs. In a risk management session provided by our malpractice carrier, we were cautioned that using the term "nurse" to refer to anyone other than a LICENSED NURSE is a felony!

I know it's old habit for medical practices to call the MAs their "nurses," but it's a habit we have had to force ourselves to break.