Licensure of Provider Often Determines E/M Level at Lipid Clinic
Published on Mon Jul 01, 2002
If you aren't coding correctly for the nonphysician practitioner (NPP) E/M services in your lipid clinic, you could be endangering your practice's health.
Increasingly, cardiology practices are operating their own lipid clinics for patients with high cholesterol and other lipid-related conditions, but because NPPs, such as registered nurses (RNs), licensed practical nurses (LPNs), dietitians, nurse practitioners (NPs), physician assistants (PAs) and clinical nurse specialists (CNSs), staff these clinics, they present a unique set of coding challenges. Coders must become experts on physician supervision and "incident-to" billing as well as low-level E/M coding to bill properly for the clinic's services. What Is a Lipid Clinic? Many cardiology practices establish a lipid clinic to provide a medically supervised lipid management program to help patients change their lifestyle to reduce the risk of cardiovascular disease.
For example, says Phyllis Cox, RN, lipid clinic coordinator at the Cardiac Health Center in Austin, Texas, a cardiologist is managing a patient but now feels that the patient requires educational counseling. The physician refers the patient to the lipid clinic. Or, Cox says, the patient may be resistant or intolerant of the anticholesterol medications he or she has been prescribed, so the cardiologist sends the patient to the clinic. The clinic may use a multidisciplinary team to offer individual education and medical management of high cholesterol. Reducing high cholesterol has been shown to slow the progress of coronary heart disease and, if managed aggressively, reverse it or significantly decrease the number of clinical events, such as myocardial infarction. The following services are typically offered by a lipid clinic: Review of medical and family history for secondary causes of high cholesterol Explanation of lipid profile results and the goals of therapy Education regarding the benefits of a low-fat, high-fiber diet, as well as medications such as statins, e.g., Pravachol Long-term monitoring of cholesterol levels and lifestyle (including diet, exercise, weight loss and the effects of anticholesterol medications). Although the clinics operate under the medical direction of one or more cardiologists (or other physicians, such as endocrinologists), patients will most likely regularly encounter an NPP when visiting the clinic. Determining E/M Service Level From a coding and reimbursement standpoint, all NPPs are not equal. Although any NPP can bill in the physician's name (assuming Medicare's incident-to guidelines are met and the NPP is permitted under state law to perform the service), PAs, NPs and CNSs are the only NPPs who can bill under their own names and report an established patient visit at a level higher than 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician). This means that the NPPs most frequently encountered [...]
