Cardiology Coding Alert

Question: From his office a cardiologist reviews lab test results and, by telephone, orders additional testing and medication changes for skilled nursing facility patients. Can the cardiologist charge for this work if the physician does not see the patient face to face? Can a nurse performing the same services from the office charge for these services as "incident to"?

Connecticut Subscriber

Answer: No. Without a face-to-face visit, the cardiologist cannot charge for his telephone evaluation and orders. A nurse also cannot bill an "incident-to" service outside of the office. In this case, no direct face-to-face service occurred between the patient and the cardiologist/nurse, even though the cardiologist discussed the results and ordered tests over the phone with the patient's caregiver.

Good news: Your cardiologist may not be giving away reviews/medical changes for free. E/M services include some related pre- and post-work time, so reviewing lab results might be included in a future related face-to-face nursing facility visit (such as 99307-99310, Subsequent nursing facility care, per day, for the evaluation and management of a patient ...).