Wiki E/M coding: How to bill behavioral health/ outpatient doctor and RN visit same day?

[ntmenendez@hotmail.com]

Hi, I billed an APRN (99213) and an RN (99211) same day. The 99211claim denied CO:96. RN is meeting with patient for either vitals and/or shot same day as they see the APRN/MD. How do I bill for the RN services for vitals? How do I bill for RN for shot? **Please note in both situations they are seeing the APRN/MD also on the same day as the RN?
Thank you

 

[TThivierge]

Ntmendez
Are services being done same day but different clinics (ie /Medicine vs /Orth vs Mental Health) add modifier 27 to Eval Mgnmt. code of 2nd visit. For the Rn taking vitals are you adding referred doctor on RN s claims? Are you just using Z dx code as primary and it is not a primary Z dx code (it may get denied). The main disease or the problem needs to be discussed such as E11, II0, or the chronic problem or current problem being treated by doctor or provider on same day by the RN. RN should use the 98966 Phone call or 99211 face to face but add ds problem first and add referring doctor on claim. Also put in documentation if face to face phone or video mode.
I hope helped you but maybe the primary dx.
Lady T

 

[ckeeney]

For injections, the only way these would be allowed as an E&M on the same day is if they are for two different diagnoses and even that, I find, is difficult to get the second service paid.

If the RN is doing vitals only or the injection is part of the APRN service (i.e. ordered for the condition being evaluated or vaccinations in a well visit), then those should be incorporated into the APRN/MD note with the an injection administration code plus the code for the injection and would not be separately billable. In this case, due to the administration code, often a 25 modifier is required on the E&M code.

Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

We only bill 99211 if the patient comes in on a separate day for an injection.

 

[ntmenendez@hotmail.com]

For injections, the only way these would be allowed as an E&M on the same day is if they are for two different diagnoses and even that, I find, is difficult to get the second service paid.

If the RN is doing vitals only or the injection is part of the APRN service (i.e. ordered for the condition being evaluated or vaccinations in a well visit), then those should be incorporated into the APRN/MD note with the an injection administration code plus the code for the injection and would not be separately billable. In this case, due to the administration code, often a 25 modifier is required on the E&M code.

Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

We only bill 99211 if the patient comes in on a separate day for an injection.

Service if for Behavioral Health, outpatient, same day, same clinic, same diagnosis:
So if an MD or APRN uses 99212-99215 and the nurse takes vitals we can not also bill 99211 with 25 for the RN. If patient sees MD or APRN and receives an injection, we can use 99212-99215 for MD or APRN with an injection code but not 99211 25?
I really appreciate the clarification. Thank you

 

[ckeeney]

Service if for Behavioral Health, outpatient, same day, same clinic, same diagnosis:
So if an MD or APRN uses 99212-99215 and the nurse takes vitals we can not also bill 99211 with 25 for the RN. If patient sees MD or APRN and receives an injection, we can use 99212-99215 for MD or APRN with an injection code but not 99211 25?
I really appreciate the clarification. Thank you

Behavioral Health medical services follow the same guidelines as any other medical service and need to follow the E/M guidelines. See especially, the paragraphs entitled "History and/or Examination" and "Services Reported Separately". An RN or Medical Assistant is part of the clinical staff and not a QHP.

An RN or Medical Assistant doing vitals on the same day as an office visit by an MD or APRN is part of the office visit by the MD or APRN and can never be separately billed. The vitals should be documented in the chart note of the MD or APRN as part of the HPI and can be done and documented by clinical staff. Our note template has a separate module for reporting the vitals and that module forms part of the MD or APRN note for that day.

An appropriate injection code could be billed on the same day (procedure) and if done then the 99212-99215 would need modifier 25.