Primary Care Coding Alert

Question:

Florida Subscriber

Practices sometimes wonder which of their staff might count as the "qualified non-physician health care professionals" mentioned in code 98960 (Education and training for patient self-management by a qualified, nonphysician healthcare professional using a standardized curriculum, face-to-face with the patient [could include caregiver/family] each 30 minutes; individual patient). The CPT guidelines preceding this code state, in part, "The qualifications of the nonphysician healthcare professionals . . . must be consistent with guidelines or standards established or recognized by a physician society, nonphysician healthcare professional society/association, or other appropriate source." A nurse trained in asthma education could also meet the criteria for this code if his or her qualifications were consistent with the guidelines or standards in question. Check with your state society about what scope of practice laws encompass, then discuss the matter with your individual payers.