Practice Management Alert

Question: From his office a physician reviews lab test results and, by telephone, orders additional testing and medication changes for skilled nursing facility patients. Can I 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 you cannot charge for his telephone evaluation and orders. A nurse also cannot bill an "incident-to" service without face-to-face, physician supervision and a physician plan of care.

In this case, no direct face-to-face service occurred between the patient and the physician/nurse, even though the doctor discussed the results and ordered over the phone with the patient's caregiver.

Good news: Your physician 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 office or nursing facility visit (such as 99307-99310, Subsequent nursing facility care, per day, for the evaluation and management of a patient ...) within the medical decision making calculations.