EM Coding Alert

Question: We have been getting calls from patients who have tested positive for COVID-19 and who want an order to go to the local hospital to receive a REGEN-COV (casirivimab and imdevimab, administered together) infusion. If the nurse triages the patient, can we charge a telephone visit for that, or does our nurse practitioner (NP) have to talk to the patient first?

Tennessee Subscriber

Answer: To bill 99441-99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian …), the patient must receive an evaluation and management (E/M) service from a physician or a qualified healthcare professional (QHP) per the code descriptors. This means that the provider, in this case your NP, must personally evaluate the patient over the phone, write out a plan of care, and provide an order for the service.

Unless state law permits, only a physician or QHP such as an NP — and not a registered or licensed practical nurse — can provide such an E/M service, which again means you cannot bill for the service. Simply triaging a patient in this way does not meet the criteria for the code choice.