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nurse-run clinics like wound care, coumadin clinic, etc

  1. #1
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    Woodland Hills, California
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    3
    Default nurse-run clinics like wound care, coumadin clinic, etc
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    Hi,

    Can anybody tell me what you're doing, as far, as coding and billing, for patients seen at nurses' clinic, ie, wound care clinic, coumadin clinic, blood pressure clinic, etc.

    Can we bill these using 99211? If yes, do we collect copays? IF not, how are you capturing these revenues?

    Any insight or suggestions will be greatly appreciated.

    Thank you,
    Sally Case, CCS, CPC, CEMC

  2. Default
    There are too many variables to your questions but basically.......

    Can anybody tell me what you're doing, as far, as coding and billing, for patients seen at nurses' clinic, ie, wound care clinic, coumadin clinic, blood pressure clinic, etc.

    wound care--can not code/bill 99211 if nurse if doing f/up work for a physician that is in a global period

    coumadin---can code/bill 99211 ONLY if there is separate work documented other than the pre- and post work that is part of the 85610 coumadin testing

    blood pressure--can not code/bill 99211 if pt comes in just asking for a BP read. Can code/bill if there is a physician order for a "5 day BP checks"

    Can we bill these using 99211? If yes, do we collect copays? IF not, how are you capturing these revenues?

    Copays---depends on the insurance. Some want a copay anytime the pt sees any provider while others require a copay only when the patient sees a MD, PA

  3. #3
    Default
    It seems to me that the bigger question is.. Can you bill insurance at all for anything if there is no supervising doctor present? No, you can't. Nurse's can't be credentialed, unless they are NP's.
    Walker Bachman, CPC, CPPM

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