# Billable nurses visits without Doctor present?



## penny48 (Feb 16, 2010)

We are having an arguement at our 6 offices, as to whether we can bill out services rendered by a registered nurse without the physician being in the office.


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## Walker22 (Feb 16, 2010)

Absolutely not.... you can't send a claim with the nurse as a billing provider, and in order for this to qualify as "incident-to", the doctor must be present in the office suite.


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## penny48 (Feb 16, 2010)

Thank you, they aren't even doing incident to they are just billing under the doctor.  I keep telling them this is illegal.


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## Walker22 (Feb 16, 2010)

Technically, it's "insurance fraud". I wish you luck in convincing them to change this practice. Hang in there!


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## penny48 (Feb 16, 2010)

Thanks I have been trying to tell them that, if all else fails I am going to go to the compliance officer.  That will stop it, mention the word "fraud"  the officer panics.....


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## mitchellde (Feb 16, 2010)

I agree with Walker, this is a bad practice.  Think of your physician's malpractice carrier, how would they feel because if anything goes wrong it will come back on the physician's malpractice because according to the claim, the physician was there!


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## FTessaBartels (Feb 16, 2010)

*RN is not the same as NP*

An RN is not the same as an NP.  The most that an RN can bill would be 99211 - if the doctor was present in the office suite.  Per CPT this type of presenting problem "*may not *require the presence of a physician."

Incident to billing requires that an qualified Allied Health Professional (such as an NP or PA) perform the service as a follow-up to an already established treatment plan.  That's a different thing and the level of service *may be *higher than 99211. 

F Tessa Bartels, CPC, CEMC


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## mbell411 (Feb 17, 2010)

Does the ruling for nurses also apply to an outpatient hospital clinic setting?


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## FTessaBartels (Feb 17, 2010)

*Who employs the nurses?*



mbell411 said:


> Does the ruling for nurses also apply to an outpatient hospital clinic setting?



Depends on who employs the nurses. If it's the doctor (professional practice), yes.  If it's the hospital, the facility fee covers the nurse's work.

F Tessa Bartels, CPC, CEMC


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## penny48 (Feb 17, 2010)

We are hospital owned practices.


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## mbell411 (Feb 18, 2010)

Our nurses are employed by the hospital..


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## mbell411 (Feb 18, 2010)

*Outpatient billing for nurses*

In the case of an RN in the outpatient facility, does the existing criteria for E&M's still apply..


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