Wiki Biller

[deanaTuorto1!]

Can a physicians assistant bill the code 29580 under their own NPI? Are there any requirements for the physician to be in the building or available electronically?

Can a nurse place an unna boot at the request of the physician and bill for 29580 under the physician? Does he have to be in the buidling? Or whether in the building or not if he has not done the change himself can we bill 29580 or only 99211?

Can a nurse replace an unna boot at the PA's request and bill 29580 under the PA? Or does the PA have to do the replacing himself? And if the nurse can do the change does the PA need to be in the building or available electronically? I do not think a nurse can do an unna boot change under a PAs orders whether or not he is in the building??

Or can we only bill 29580 if the physician himself does the unna boot change? And all others can only bill 99211?

I have found so much conflicting information regarding this issue. Any advice would be very helpful. Thanks

 

[thomas7331]

A PA, if billing under their own NPI, can perform this without the physician in the building (although the PA's practice must be within the scope and appropriately supervised by the physician under the terms of their license). If billing under the physician's NPI, then the physician does have to be in the building in order to meet the 'incident to' requirements.

Rules for billing nurses' services are different depending on whether you're in an office or facility setting. Nurse may perform services that are within the scope of their license - placing an Unna boot usually is included in this, and if so, it is not necessary for the physician to personally place the Unna boot. But in an office, those services may only be billed by the physician if they meet the definition of 'incident to', which includes direct supervision - the physician must always be present in the office. I am not sure about whether or not a PA may supervise office staff and have services billed under their credentials, so that is something you may want to research further - it may vary by state according to license rules.

In an outpatient hospital setting, nurse services can only be billed by the facility - 'incident to' billing is not allowed. The physician may not bill a professional fee unless he or she personally performed the service. Under CMS rules, CPT code 29580 may be performed under 'general supervision' rules, which does not require the physical presence of the physician, but the service will only be billed as a facility fee - it is not possible to bill physician claim in this situation.

Supervision and 'incident to' requirements are indeed confusing - I hope this helps some.

 

[deanaTuorto1!]

Thank you Thomas