Wiki Billing for RN and MA at a school

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arbucklej

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Hello,

We are starting a new program called The Primary School to provide services on campus to elementary school students that are impacted by poverty and systemic racism. It brings together all the adults in a child's life, including, parents, educators, and medical and mental health providers, starting at a very early age - age 4 to start.

Our RNs and MAs will work out of a nearby clinic in our system and will provide these services at the school two days a week:

  1. Health screenings (i.e. hearing, vision, etc)
  2. Immunizations
  3. Care management for chronic conditions (i.e. Asthma)
  4. Telehealth services for acute clinical conditions
  5. Scheduling appointments, such as well-checks
  6. Collaboration on curriculum at the school and/or delivering trainings and workshops on healthy behaviors (sleep, nutrition/obesity, exercise, mental health)
We were recommending E/M nursing visit 99211 for some of these services. Is there anything else here that would be allowed? The immunization itself probably, the rest I'm thinking is just 99211. The telehealth I think will be billed if the MD sees the patient via phone or video from his office.

Has anyone had experience with this. Is there a good resource you've found on the guidelines?

TIA!
 
It would not be correct coding to bill 99211 for these services. 99211 is for the continued evaluation and management of a specific problem that has already been personally diagnosed by the supervising MD and for which there is an established plan of care under which the RN or MA is giving continued treatment. In other words, it represents a patient-specific and problem-specific service, and shouldn't be used for screenings, well-checks, or generalized group programs that you describe here in #s 1, 5 and 6 (and you cannot bill for scheduling an appointment). In addition, 99211 requires direct supervision by the provider, so the MD would need to be on site at the time the service was provided if you are going to bill that for #s 3 and 4 for any specific patients.

The only think I see that is really eligible to bill to insurance is the immunizations. You may want to check with specific payers regarding whether or not the services you describe in #6 are a covered preventive benefit and if so, how they would wish you to bill this, but I think in most cases you'll find that this is something that is not normally covered by most plans. The type of program you are describing here sounds more like something that would normally be publicly funded or underwritten by a grant rather than something that you would support through billing individual services to each patient's insurance plan.
 
Last edited:
thomas7331 said:
It would not be correct coding to bill 99211 for these services. 99211 is for the continued evaluation and management of a specific problem that has already been personally diagnosed by the supervising MD and for which there is an established plan of care under which the RN or MA is giving continued treatment. In other words, it represents a patient-specific and problem-specific service, and shouldn't be used for screenings, well-checks, or generalized group programs that you describe here in #s 1, 5 and 6 (and you cannot bill for scheduling an appointment). In addition, 99211 requires direct supervision by the provider, so the MD would need to be on site at the time the service was provided if you are going to bill that for #s 3 and 4 for any specific patients.

The only think I see that is really eligible to bill to insurance is the immunizations. You may want to check with specific payers regarding whether or not the services you describe in #6 are a covered preventive benefit and if so, how they would wish you to bill this, but I think in most cases you'll find that this is something that is not normally covered by most plans. The type of program you are describing here sounds more like something that would normally be publicly funded or underwritten by a grant rather than something that you would support through billing individual services to each patient's insurance plan.
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Hello! I really appreciate this thoughtful response. I am sorry it took so long to reply to you with a thank you!:)
 
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