Wiki House Calls- Incident To

Create Wiki Sort by date
K

kedwards41

Guest
Messages
1
Location
Boise, ID
Best answers
0
Hello, I work for a house calls company here in the valley and we have medical assistants who go out to patient homes to draw labs ordered by our NPs. My coder states that we cannot bill a 99211 "incident to" because the provider needs to be readily available should a problem arise. In these situations our providers are elsewhere, the MAs are by themselves but have the providers available on the phone (video and audio) if needed. Is my coder correct or am I able to bill for these Ma (Nurse) visits? Please advise.
 
0
kedwards41 said:
Hello, I work for a house calls company here in the valley and we have medical assistants who go out to patient homes to draw labs ordered by our NPs. My coder states that we cannot bill a 99211 "incident to" because the provider needs to be readily available should a problem arise. In these situations our providers are elsewhere, the MAs are by themselves but have the providers available on the phone (video and audio) if needed. Is my coder correct or am I able to bill for these Ma (Nurse) visits? Please advise.
Click to expand...

Your coder is partially correct. One of the requirements of 'incident to' is direct supervision, which in normal times means that the supervising physician or NPP under which the service is billed must be on site.

However, during the COVID-19 emergency, CMS has allowed some flexibility to this to allow for 'virtual supervision':

For the duration of the PHE for the COVID-19 pandemic, CMS revised the definition of direct supervision to allow direct supervision to be provided using real-time interactive audio and video technology. We recognize that given the risks of exposure, in some cases, technology would allow appropriate supervision without the physical presence of a physician. We note that in specifying that direct supervision includes virtual presence through audio/video real-time communications technology that this can include instances where the physician enters into a contractual arrangement for auxiliary personnel as defined in federal regulations at §42 CFR 410.26(a)(1), to leverage additional staff and technology necessary to provide care that would ordinarily be provided incident to a physicians’ service (including services that are allowed to be performed via telehealth). Additionally, we note that this change is limited to only the manner in which the supervision requirement can be met, and does not change the underlying payment or coverage policies related to the scope of Medicare benefits, including Part B drugs. (see link below)

So as long as all of the other 'incident to' requirements are met, you may be able to bill this if the virtual supervision is in place, at least while the COVID-19 emergency is in effect. However, I'd note that simply drawing labs does not qualify for a 99211 - that code requires a specific E&M service be ordered by the physician and performed by the physician's staff member (for example, a medically necessary blood pressure check).

 
You must log in or register to reply here.
Top