# nurse visit - physician is asking



## Tricia13 (Feb 7, 2012)

My understanding of a nurse visit in the context of using it when performing a PT INR is that if vitals are taken, the nurse visit is acceptable to use.  My physician is asking if we use it because medical decision making is being done, but my take is any time there is further evaluation or management beyond just the blood draw and coagulation reading.  Anyone have any thoughts?


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## mitchellde (Feb 7, 2012)

if it is a visit for a blood collection only then you cannot use a 99211 you can use the CPT code for blood collection, taking vitals does not make it a 99211.  The nurse is following physician orders from a previous encounter and is not doing anything beyond those orders, also vitals signs are an intergral component of every procedure we offer, as it is important to know so that the result of the lab can be thouroughly evaluated.  There is no MDM component for a 99211 the nurse cannot independently evaluate a patient.  the 99211 is a physician level of service allowed for the provider to charge when another qualified ancillary person is the one face to face with the patient carrying out orders from a previous encounter with the physician.  If there is a separate CPT for this activity you cannot elect to use the 99211, if there is no CPT then the 99211 may be used.  Such as there is no CPT code for the ear irrigation so when the patient returns to have their ears irrigated then it may be charged as a 99211.


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## Tricia13 (Feb 7, 2012)

Okay, I understand that.  So, according to our MAC states a 99211 with a 85610 would be used when there is a need for a clinical E&M, such as an evaluation for any new symptoms.  Our patients are routinely queried for habits and anything that might compromise their coagulation.  ?


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## mitchellde (Feb 7, 2012)

If the patient were having new symptoms it would need to be physician evaluated.  They are saying you can have a very minimal provider encounter with a blood draw yes.  But it would need to be a physician face to face to address something very minor not related to the blood collection.  But the nurse could not do that as it would not meet the incident to definition.


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## Tricia13 (Feb 7, 2012)

This is our MAC's interpretation of incident to:

Requirements for “incident to” are:

The services are commonly furnished in a physician's office.

The physician must have initially seen the patient.

There is direct personal supervision by the physician of auxiliary personnel, regardless of whether the individual is an employee, leased employee or independent contractor of the physician.

The physician has an active part in the ongoing care of the patient.
*Direct supervision in the office setting does not mean that the physician/non-physician must be present in the same room with his aide. However, the physician must be present in the office suite and immediately available to provide assistance and direction while the aide is performing services.*

Is this the same understanding you have for incident to?  Thanks for your input.


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## LLovett (Feb 7, 2012)

*Who is your MAC?*

Those are the definitions of incident to but 1 key piece is missing.

The physician has to see the patient initially for that specific problem.

So they are incident to for issues that are established but if they present with new complaints those complaints can not be considered incident to.

Laura, CPC, CPMA, CEMC


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## mitchellde (Feb 7, 2012)

Yes I gree with everything.. That is why when the patient comes in with a complaint while there for a PT/INR blood collection the nurse cannot take care of this and use a 99211.


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## Tricia13 (Feb 7, 2012)

Okay, gotcha, thank you.  Our MAC is Trailblazer Health Enterprise.


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