Wiki Nurse visits and UAs

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Tazlar

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Our coding dept is being requested to bill out a UA with a 99211. I know as it is an E&M I can add a 25 modifier. I am having trouble with this because of the UA having its own CPT code and by my understanding of E&Ms you can only bill both if there is a separate reason for the E&M service. Is there a documented reason and a coding guideline for not being able to do this? I am just wanting to make sure we are not doing something that would cause red flags or repercussions along the way. I have received one answer from another thread but that did not satisfy my manager. I am hoping for more information.

Thanks so much, in advance
 
A nurse cannot evaluate a patient a make a decision that a UA is needed. The physician must determine either in a previous visit or in a phone visit that the patient is to present for the purpose of collecting the UA. Therefore the medical necessity for this service has already been performed and the is nothing more for the nurse to do except follow orders from this previous encounter. Vital signs if taken are an integral part of collecting the UA. There is nothing the nurse is providing that is over above and beyond the service previously ordered therefore you have no basis for the office visit.
 
Once again I thank you for the answer. I can only hope and pray that our office manager listens to this one...the saga continues
 
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