# RN and OV



## ebredehoeft (Aug 5, 2010)

Isn't the only visit an RN could bill for is the 99211 or can they bill for other established visits as well. I thought a Physician had to be present for the other visits?

Thanks,


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## mitchellde (Aug 5, 2010)

A nurse cannot charge visit levels at all.  99211 is a physician level, it is a level the physician is allowed to charge when a qualified medical staff member is the one with the patient carrying out physician orders from a previous encounter and the physician must be with the office area while the patient is being seen.


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## ebredehoeft (Aug 5, 2010)

Okay well now I am even more confused because the cpt book states
" 99211 for the evaluation and management of an establisted patient, that may not require teh presence of a physician."

And I have an example in a text book that shows
17 year old football player comes into clinic for a gold injection by a nurse. Only the nurse sees this established patient. It codes this as a 99211.

So that is why I would think a nurse could see a patient for a 99211 but not any of the others including Nursing home visits such as 99304 or 99307.

I do apperciate the input as I am trying to figure this out and am a bit rusty at the e/m codes


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## mitchellde (Aug 5, 2010)

That means the physician does not have to be physically in the room with the patient but the physician must be within the office suite area.  A nurse cannot diagnose and prescribe treament they can follow physician porders.  In your example the patient must have been evaluated prior for the need for the inject and this was schedule to be done then by the nusre at this encounter.  You cannot charge a 99211 for an injection since the assessment of the patient has already been perforemd for this service and a CPT exisits for the injection administration.  You can use a 99211 for an RN (or any qualified staff) to see a patient per a physicians order if no other CPT code exisits for the service rendered.  If there is no physician within the office suite area then you cannot have the RN seeing patients and bill using the physicians number.  Remember that home health nurse are goverend by a completely different set of rules.  But if you are a physician office POS 11 then the NPI you use as the rendering/supervising provider in field 24J, must be present in the office while the patient is being seen.


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## ebredehoeft (Aug 5, 2010)

Thank you for the feed back I totally agree with you. I thought that was a little odd going back and reading that about the injection. I would have originally thought that you would of just charged an injection admin and not a E/M visit. 

So basically 99211 is saying that it is a low enough level of service where the doctor can say yes that needs to be done but a nurse can perform it. Right?

Thanks again for your help I apperciate it and it is great to have fellow coders to pick each others brains on what we know.


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## mitchellde (Aug 5, 2010)

I am not sure what you mean by the 99211 is low enough for the doc to say  yes...
For the injection the physician surely has seen the patient at a encounter on a previous visit where the decision to give this injection was made.  As a part of the the physicna set up a plan of care to have the patient return so the nurse could administer repeat injections.  So when the patient returnes it is just an injection.  If the patient has never been evaluated for the need for this injection then the patient must be evaluated by the physician for their problem and then if the physician states the nurse should administer the injection at the same encounter you will bill the ov (any level as long as documentation supports) with 25 modifer and the administration and the J code for the drug.


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## ebredehoeft (Aug 6, 2010)

Thanks for the input I appericate it.


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