Wiki Which of us is correct? HELP

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StacyGalloway

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I have started billing for a NP in a family practice setting. Previous biller told NP that she could bill for 99213 even when the nurse for the NP did all the work and all the NP did was review the medical record. NP did not spend any face to face time with the patient. I just need someone to verbally confirm my thoughts that the 99213 requires face to face with the NP. I already have cited the AMA's CPT guidelines for 2023 where is states "These guidelines are for services that require a face-to-face encounter with the patient and/or family/caregiver." and that "99211 and 99281 are the face to face services may be performed by clinical staff." Who is right here?
 
StacyGalloway said:
I have started billing for a NP in a family practice setting. Previous biller told NP that she could bill for 99213 even when the nurse for the NP did all the work and all the NP did was review the medical record. NP did not spend any face to face time with the patient. I just need someone to verbally confirm my thoughts that the 99213 requires face to face with the NP. I already have cited the AMA's CPT guidelines for 2023 where is states "These guidelines are for services that require a face-to-face encounter with the patient and/or family/caregiver." and that "99211 and 99281 are the face to face services may be performed by clinical staff." Who is right here?
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You are right.

An RN can't bill incident-to an NP. If that's the kind of advice the previous biller was giving, it makes me nervous what other issues you'll uncover!
 
sls314 said:
You are right.

An RN can't bill incident-to an NP. If that's the kind of advice the previous biller was giving, it makes me nervous what other issues you'll uncover!
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Just to clarify - I believe the NP could supervise the RN, but without NP personally seeing/evaluating patient, it is only 99211.
 
Depending on the payer (Medicaid in some places) and type of service, an RN could *possibly* independently see a patient in this scenario.
 
csperoni said:
Just to clarify - I believe the NP could supervise the RN, but without NP personally seeing/evaluating patient, it is only 99211.
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Thanks for adding that. I was looking at it specifically from the 99213, because the OP had mentioned citing the CPT reference for 99211. It's good to have the 99211 restated clearly though, because you never know who's reading responses and taking advice from them.
 
devil's advocate here- i do agree that face-to-face is best however, the actual descriptions of 99212-99215 do not say that face-to-face is required. if the NP is reviewing the medical record & doing the MDM portion of the visit or going for time they can bill whatever code they support per the new guidelines. keep in mind they can only bill for their own time not anything a non-billable provider (MA,RN) did. of course- copying & pasting a hx & exam that wasn't really done would be fraud but if there was a narrative with a "medically appropriate" hx & exam in the note that could pass for a visit. hopefully this isn't something that occurs frequently as i wouldn't call that best practice but if it's a rare occurrence it should be ok under the new guidelines. i would also make my NP aware that by putting their name on a record & signing it they are stating that they actually did the things in that record. sometimes the legal aspect influences people to change their practices!
 
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