Open Forum

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

I'd love to see any of those resources, Bassem! Feel free to email them to me at ashley.martin@llchc.org. Thank you!

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

I'd love to see any of those resources, Bassem! Feel free to email them to me at ashley.martin@llchc.org. Thank you!

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Hi Bassem - would love to see what your team has put together. Please feel free to email me at samantha_colontuono@rush.edu

Thank you!

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Great topic and relevant to some of the work we are doing right now in our clinics. Tacking onto this thread...With regard to the nurse visit itself, we are getting some pushback from providers asking if nurse visits can be done without a provider in office. As a rule, we have never allowed this in the past, but one of our Lead Physicians wants to see the regulations that require this, and I have not been able to find anything explicitly stating that they cannot complete without a provider. For context, we are located in Massachusetts. Provider-based billing site that provides primary care and OBGYN services. Many of our practices existed in the past as privately owned and now being part of a larger health system, our interpretation of risk is not always the same. Any insight or policies you can share are appreciated. Thanks!  

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Good Morning Bryony,

I work for an FQHC in California and we are highly restricted here.  Our clinics finance department developed a billing policy for us which I have included for your review and I hope you find some of the information helpful to your particular setting.

1.  How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?  Our (billable) nurse visits are defined as an in-person visit that occurs on a day where a patient does not see a clinician (NP, PA, MD).  We created a separate RN template where the nurses document a comprehensive assessment which meets the needed criteria.  We also check vital signs even at our educational appointments, even though we aren't necessarily doing a comprehensive assessment.  (refer to attached documents for billing criteria)

·    2.    Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.    We can put in an administrative code when providing series injections in addition to the 99211

·   3. ·   How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?  As an FQHC we cannot bill for the annual wellness visits.  The RN does see the patient and completes a majority of the work for the clinician but the billing is coded by the clinician not the RN. That's how we are required to manage those visits here. A different State or a non-FQHC might be allowed something different.  

·      Please feel free to reach out to me if you have any questions about the resources I've included.

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org

Dear AAACN Team,

I am reaching out to seek clarification and guidance regarding best practices for nurse visits and appropriate charging for nursing work in the ambulatory care setting. I work for a hospital system in Madison Wisconsin that has both physician-based (billing) and hospital-based (billing) clinics. 

Specifically, we are reviewing our current processes and would appreciate your insight on the following:

·       How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?

·       Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.

·       What are other organizations doing to bill for 99211 in nurse-led appointments?

·       How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?

·       If any organizations have developed guidelines to describe this work, I would greatly appreciate if you could share those resources.

Your expertise and guidance would be invaluable as we work to maintain high standards of care and operational integrity. Please let me know if there are specific resources or contacts you recommend.

Thank you for your time and support.

Warm Regards,

Bryony Kelleher, DNP, RN, AGCNS-BC

RN Clinic Supervisor, Geriatrics

5543 E Cheryl Pkwy, Fitchburg, WI 53711

bkelleher@uwhealth.org