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Can a nurse bill a 99213 ??

  1. #1
    Location
    Salt Lake North
    Posts
    725
    Default Can a nurse bill a 99213 ??
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    Dumb question time folks. When patient's come to the clinic, some of their treatment may be done by a nurse. But our clinic is sometimes billing a 99213 for when the patient has seen the nurse only, not the doc. Can this be billed??

  2. #2
    Default
    99213 requires a physician spending 15 minutes face to face with patient and/or family and requires 2 of 3 components. Nurse visits are 99211.
    Kiana CPC, CPC-H, BCS-M, BCS-R

  3. #3
    Location
    Salt Lake North
    Posts
    725
    Default
    Thank you for your confirmation !

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default Is your nurse an NP?
    If the nurse is an NP, the NP should be able to bill any level of E/M.

    F Tessa Bartels, CPC, CPC-E/M

  5. #5
    Default
    Midlevels can provide E/M at other levels as long as it meets the components of the visit and it is MDM driven.
    Kiana CPC, CPC-H, BCS-M, BCS-R

  6. Default
    If the nurse is a NP, they could bill any level. If not a NP, 99211.
    ~Amy, CPC, CPMA, CEMC~
    Auditor/Consultant

  7. #7
    Location
    Chicopee, Massachusetts
    Posts
    26
    Default
    Does anyone have any documentation of this from CMS, etc?

  8. #8
    Location
    Columbia, MO
    Posts
    12,890
    Default
    FYI - the 99211 is a physician level also and can billed for a nurse only encounter as long as it meets the incident to requirements. For the patients in the first post that just walk in and see the nurse only and this is not part of a planned follow up by the doc then those visits cannot be billed even with a 99211.
    As far as back up documentation just look at the definition in the CPT book for the visit levels and then the CMS definition of incident to.
    Also CR1776 from 2002 on shared encounters as some wnat to call these nurse type encounters a shared encounter, and that is fine except the physician must face to face with the same patient on the same day and must write his own exam note. To sign off on the nurse documentation is insufficient for it to be billed under the physicians number.

    Debra A. Mitchell, MSPH, CPC-H

  9. Default Question regarding Observation
    I'm new to the coding world and have a question regarding Observation status Our facility has 99219 only, hard coded into their Charge Master. It is my understanding that coding observation depends on the the Evaluation and Management of the patient at that point in time. Do your facility coders review all Observation cases and code accordingly??
    Another question is regarding the number of hours in Observation. I understand that Medicare codes for Observation hours of 8 or greater? What do you do with pt's who are seen ie.. in Labor and Delivery and are coded for less than 8 hours with Observation time??

  10. #10
    Location
    Columbia, MO
    Posts
    12,890
    Default
    facility coding of E&M is completely different than physician. The level for the facility is dependent on your facility's criteria for that type of encounter and level. There does not have to be any correlation between the facility E&M level and the physician level.

    Debra A. Mitchell, MSPH, CPC-H

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