Wiki New Patient - Nurse Visit

[pvang]

Hi-

What E/M code would you use for a new patient who is only visited by a nurse? This patient was on board a ship for vacation when he fell ill and a nurse was called to evaluate him/treat him. I thought about coding 99211 but in this instance, the patient is new not established. Thoughts?

Thanks!

 

[mitchellde]

A nurse in a physician setting cannot see and evaluate and treat a new patient so you cannot bill it.

 

[Vochoa4190]

Where are you getting that information from? Can you provide the link?

 

[mitchellde]

Where are you getting that information from? Can you provide the link?

An RN/LPN is not credentialed and has no NPI number to be billed with. A new patient encounter cannot be incident to nor a shared encounter. It can be a physician encounter billed under the performing physician NPI, an NP billed under the NP NPI , and in some states a PA billed under the PA NPI. There is no link for this it is standard billing rules. Why are you thinking these are billable encounters?

 

[katiemma]

Same sort of question but just need clarification. We do RN led visits at my clinic and one of the providers asked if an RN led visit can be done on a new pt in the cases we need extra help in the clinic when we are short staffed. I said no because this would be considered incident to since the RN is not credentialed. Is this correct or is there a better way to explain this to the providers?
Thanks

 

[csperoni]

Same sort of question but just need clarification. We do RN led visits at my clinic and one of the providers asked if an RN led visit can be done on a new pt in the cases we need extra help in the clinic when we are short staffed. I said no because this would be considered incident to since the RN is not credentialed. Is this correct or is there a better way to explain this to the providers?
Thanks

Incident-to is a BILLING/CODING guideline and one of the several requirements is that it must be an established patient with an established plan of care.
I think this falls more into a scope of practice issue. RNs are not permitted to diagnose a patient, order tests, or prescribe.
RNs can certainly triage, and sort of prepare the patient for evaluation by physician/ACP. They can carry out the instructions (within their scope of practice) from the physician/ACP.
Unless an "RN led visit" simply means the RN is just starting the process, but the patient is examined/evaluated by the physician/ACP, I'm not sure how legally compliant this would be.