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klovemeister@hotmail.com

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Can someone please help me code this scenario:
PHN sees a patient for a quick office visit (i.e. pregnancy test visit) worthy of a 99211. Patient's pregnancy test come back positive and requests for further guidance. NP comes in for a visit worthy of a 99213. Can I bill both 99211 and 99213 together, listing the nurse's NPIs for their provided service and using modifier 25?
Please help! Thank you!
 
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An RN cannot initiate a visit with a patient, if it is a "nurse visit" then it must be incident to a provider encounter for the same diagnosis and plan of care. If a provider also visits the patient on the same day you can bill only the provider encounter you cannot bill the 99211 and the 99213 for the same day.
 
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An RN is not a recognized provider type for most payers and likely does not have an NPI number to even bill under. The billing for nurse visits is typically done under the provider's NPI following incident-to rules. In most cases, only one E/M can be billed per day per group/specialty. The notes can be combined when determining the level to be billed. Per CMS, "As for all other E/M services except where specifically noted, carriers may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office or outpatient setting which could not be provided during the same encounter (e.g., office visit for blood pressure medication evaluation, followed five hours later by a visit for evaluation of leg pain following an accident)."

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/MM4032.pdf
 
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Thank you both, I have a hard time with the different nurse types. I was mistaken and an NP comes in, not an APN. I was able to get more specific examples:

If a patient comes in for a nurse visit for pregnancy test, found to be positive and then I go in to do counseling.

Or: A patient comes in for birth control refill with a nurse. In the visit she complains of vaginal symptoms so the NP goes in and does an exam and recommend rx. The nurse completes all the counseling and dispenses the medication.
 
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I was mistaken and an NP comes in, not an APN. I was able to get more specific examples:

If a patient comes in for a nurse visit for pregnancy test, found to be positive and then I go in to do counseling.

Or: A patient comes in for birth control refill with a nurse. In the visit she complains of vaginal symptoms so the NP goes in and does an exam and recommend rx. The nurse completes all the counseling and dispenses the medication.
 
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In the scenarios that you have described above, only the visit with the nurse practitioner would be billable. Here is from the Chapter 12 of the Medicare Claims Processing Manual which applies to both physicians and non-physician practitioners (PA, NP, CNM, etc.):

30.6.5 - Physicians in Group Practice
(Rev. 1, 10-01-03)

Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf
 
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AmandaBriggs said:
In the scenarios that you have described above, only the visit with the nurse practitioner would be billable. Here is from the Chapter 12 of the Medicare Claims Processing Manual which applies to both physicians and non-physician practitioners (PA, NP, CNM, etc.):

30.6.5 - Physicians in Group Practice
(Rev. 1, 10-01-03)

Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf
Click to expand...
Thank you SO MUCH!!
 
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