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Nurse service Injection

  1. #11
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    So, if a medical assistant gives a depo injection (patient provides own meds) when the physician is out of the office, is this not billable?

  2. #12
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    One has to wonder if this is an error in CPT - but I can't find it posted as an error on the most current errata sheet.
    Lisa Bledsoe, CPC, CPMA

  3. #13
    Default nurse injection
    So am I missing something? If the Dr is not in the office, patient brings in medicaiton, nurse gives an injection (usually 96372) there is nothing they can charge?

  4. #14
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    This is one of those things that the more you dig, the more confusing it gets!

    We don't bill nurses services (or any ancillary staff, like MAs) if there isn't a doctor in the building because of Medicare's incident to guidelines:
    http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf

    Though, as I see in CPT under 96372, it does say "Physicians do not report 96372 for injections given without direct physician supervision. To report, use 99211". The first part is confusing, as Lisa said, and also it sounds like if there wasn't a physician in the office, you could bill 99211, which would conflict with Medicare's guidelines.

    It's good to have an office policy to defend your billing if there was an audit. We have a schedule of who was in the office to show who was "doctor of the day" to be on those charges for nurse only services.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  5. #15
    Default nurse service
    Yes, I am confused with this one. But I have been researching (again!!!) and have found a couple of very interesting articles. This one seems to sum it up most clearly.

    According to Medicare: even though the 99211 code does not require the presence of the physician in the patient's room or a face-to-face encounter with the physician, the service would be done by face-to-face encounter with the physician's staff and “incident to” (the physician must be in the office suite and immediately available.”) a physician's service.
    In other words, CPT code 99211 does require a documented face-to-face evaluation by a physician's staff member and a physician service (change in a medical regimen) that has an impact on the patient's care.
    Medicare's statement gives us three general questions to ask when evaluating the appropriate use of CPT code 99211. Remember, these questions must be answered affirmatively when deciding whether or not to use CPT code 99211.
    1. Was the “Incident to” rule met (was the provider on site)?
    2. Was the service medically necessary and not just routine (there must be a change in the medical regimen performed while the patient is in the office)?
    3. Was the service face-to-face (did you or a staff person talk to the patient in person and not via phone)?
    PDF] CPT Code 99211/ Are You Being Paid For PT/INR Office Testing

    Thanks to everyone for helping me try to understand this mess.

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