Outpatient Facility Coding Alert

You Be the Coder:

Know How to Bill the "Nurse Visit"

Published on Mon Sep 21, 2015

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Question: What behavioral health codes can a nurse bill? Can she bill for 99212, 99213, 99214, or 99215 for her time or are those codes only for the doctor’s time with the patient? Also, can we bill for the nurse administering injections

Colorado Subscriber

Answer: In the office setting, an RN cannot bill for a 99213-99215, even under the physician’s NPI. RN’s can report 99211(Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) and bill under the supervising physician on staff for that particular date of service. Code 99211 usually is referred to as a “nurse visit.” You should review the “incident to” guidelines to make sure that all requirements have been met prior to billing.

Injections are also services that nurses can provide and would be billed under the supervising physician. When injections are performed, they do not require the presence of the physician in the treatment room.

In the hospital outpatient setting, under Medicare, HCPCS G0463 (Hospital outpatient clinic visit for assessment and management of a patient) may be appropriate. Much will depend upon the nature of the visit. For example, if the reason for the visit is an intramuscular injection, you should report only the medication and code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance, or drug; subcutaneous or intramuscular]) for its administration.