Wiki New patient immunization or lab draw

Create Wiki
M

maryek28@outlook.com

Networker
Messages
49
Location
Douglas, AK
Best answers
0
Our clinic sometimes sees new patients who only want a flu shot or and STD check. They only see the nurse. I know we can't bill any E/M codes for these situations, but can we bill these at all since they weren't seen by the provider? I'm a little confused about how incident-to billing works in this situation.
 
It would need to be billed under the NP's NPI. Incident-to needs to be established patient, established plan of care. Immunization would be the injection charge and the drug. STD check i assume there are lab codes that are billable?
 
I think they mean RN visit not NP. Which would mean the services would not be billable since the provider had not evaluated the patient and ordered the services. Honestly the patient should not be seen by only ancillary persons with no provider evaluation. The RN is not licensed to evaluate a patient for the necessity of these services.
 
Immunizations are sometimes exempt from 'incident to' requirements under payer rules as they can be administered with a standing order, so it may be acceptable to bill a flu shot without having had a visit with the provider first - you may with check with your payer policies on this.

An STD test, however, is diagnostic, and the patient should have some kind of evaluation by a provider first with an order written for this test in order to support medical necessity, as per the posts above. A nurse cannot order lab services or other diagnostic tests and in not meeting 'incident to' definitions, it would technically not be a covered service.
 
Check to see if standing orders can apply to a new patient, every time I have checked on this they cannot apply to new patients, only established.
 
You must log in or register to reply here.
Top