Pediatric Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: When a nurse performs a procedure such as inserting an NG tube, drawing blood or catheterization, how should we bill?

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Answer: If a nurse performs an nasogastric (NG) tube insertion, bill only 99211 (office or other outpatient visit ... established patient). The NG tube (CPT 43752 , naso- or oro-gastric tube placement, necessitating physician's skill) code descriptor specifically states that a pediatrician must perform the procedure.
 
In fact, this code is a good example of why you might want to hire a physician extender if you don't already have one. A pediatric nurse practitioner or a physician assistant can perform the tube insertion, while a registered nurse in a primary-care pediatrician's office probably can't (if it's a pediatric gastroenterologist's office, she probably can but can't bill separately).
 
If the nurse performs blood collection (36415, routine venipuncture or finger/heel/ear stick for collection of specimen[s]) or catheterization (53670, catheterization, urethra; simple), the procedures can be billed. The RVUs for some of these codes do not include physician work, just the practice expense. For example, catheterization and cerumen removal RVUs include some physician work, while nebulization has none.