This is a two-part question. Clinical guidelines and billing guidelines (assuming you are billing 99211) per payer/carrier.
It is my understanding that some payers may require a provider to be physically present when billing 'incident-to' charges. Depends on your region and contracts.
Clinical guidelines and policies may reasonably restrict administration of things like allergy injections without a provider present, while allowing weight checks, blood draws and BP checks for example.
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Leslie McDowell ANP-BC DNP RN
Northwest AHEC/Wake Forest Univ Sch of Med
Winston Salem NC
(336) 972-7852
ANP-BC DNP RN
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Original Message:
Sent: 02-14-2025 11:37
From: Sarah Worm
Subject: Nurse Visits without Medical Provider On Site
Hi! I'm reaching out for any input or procedures that anyone may have already created that outline what nurse visits could be completed with a patient, without a medical provider on site. Generally, our nurses perform nurse visits independently for various reasons including those listed below, using standing orders, while providers are on site seeing patients. We have run into situations when providers call out, leaving RNs on site with other support staff. Is there any guidance on what can and can't be completed with a nurse independently without a provider present? Our nurses have given pushback about doing anything with a patient without there being a provider on site.
Nurse Visits:
Blood Pressure Checks
Injections- vaccines, previously ordered B12 or testosterone, depo provera
Suture/Staple removal
Patient education
Allergy Injections
PPD placement/reading
Weight Checks
Hemoglobin A1c
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Sarah Worm, MSN, RN
Medical Clinical Care Director
Choptank Community Health System
Denton, Maryland
(410) 479-2650
shenry@choptankhealth.org
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