Open Forum

 View Only
Expand all | Collapse all

Nurse billing with cpt 99211

  • 1.  Nurse billing with cpt 99211

    Posted 06-01-2023 07:40
    Just curious if any ambulatory practices are using CPT code 99211 for nurse billing when triage or patient education is done? Would be curious of any guidelines used. Our office handles telephonic triage and patient education in person and telephonically. I feel our health system is missing out on billable revenue albeit not a lot of monies but nonetheless a positive cash flow.


  • 2.  RE: Nurse billing with cpt 99211

    Posted 06-02-2023 11:47
    We are interested in this as well.
    We provide triage services as well as Condition Focused follow up assessment calls.

    Great to hear from orhers on this.

    Virginia R Byrnes, RN, MSN
    Clinical Supervisor 
    Health Link 
    Mary Washington Healthcare 
    This electronic message transmission, including any attachments, contains information from Mary Washington Healthcare which may be confidential or privileged. The information is intended to be for the use of the individual or entity named above. If you are not the intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this information is prohibited. If you have received this electronic transmission in error, please notify the sender immediately by a "reply to sender only" message and destroy all electronic and hard copies of the communication, including attachments.





  • 3.  RE: Nurse billing with cpt 99211

    Posted 06-03-2023 13:13
    FYI, its not just about ..." missing out on billable revenue albeit not a lot of monies but nonetheless a positive cash flow." ... it also provides a structure for measuring nurse indicators and the value of nursing interactions. 

    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

    Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]

    Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute 

    Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing


    Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084 

    T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229 

    mobley@rowan.edu | som.rowan.edu 


    Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].





  • 4.  RE: Nurse billing with cpt 99211

    Posted 06-04-2023 06:51

    Hi Aleesa, yes most definitely it also allows the nurse to work at the top of her scope. Do you have experience utilizing this billable code? I'd appreciate examples on how it's being used. Thank you. 

    Debbie 



    ------------------------------
    Debra Washko RN
    Practice RN
    Northwell Health
    Huntingtn Sta NY
    (775)240-6126
    ------------------------------



  • 5.  RE: Nurse billing with cpt 99211

    Posted 06-04-2023 17:55
    First, let us not assume all nurses are women "... allows the nurse to work at the top of her scope."

    The use of 99211 demands interprofessional collaboration with the physician provider.

    You must get the physician to indicate in their encounter note that the patient will follow up with nursing for " blood pressure check," "assessment of medication effectiveness or adverse reaction" "diabetes education" "assessment of peak flow meter monitoring," etc. 

    The nurse visit must be "incident to" something in the plan of care documented by the provider on a previous visit in order to be billable.  

    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

    Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]

    Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute 

    Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing


    Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084 

    T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229 

    mobley@rowan.edu | som.rowan.edu 


    Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].





  • 6.  RE: Nurse billing with cpt 99211

    Posted 06-04-2023 20:22

    We primarily use it on nursing visits (outpatient wound care clinic) for dressing changes or educating patients/caregivers on dressing changes or compression therapy.



    ------------------------------
    Lauren Leimbach BSN, RN, CWCA
    Centrastate Med Ctr
    Morganville NJ
    (732)610-4583
    ------------------------------



  • 7.  RE: Nurse billing with cpt 99211
    Best Answer

    Posted 06-02-2023 20:30
    Hello 
    Great questions!  99211 cannot be used to bill for a new problem or diagnosis.  Triage is usually a new problem.  The rationale used for this is that the RN license does not allow independent diagnosis. This is an example in which your practice may allow the RN to treat by protocol but despite that, it doesn't meet billing requirements that do not allow RNs to diagnose and treat.
    Education can often be billed.  There needs to be evidence that it is part of the patient's plan of care or through an order placed by a billing provider.  Again a good example in which our scope allows us to educate but we need to have evidence that it is part of the plan to bill for it.  I hope this is helpful.
    Stephanie 






  • 8.  RE: Nurse billing with cpt 99211

    Posted 06-04-2023 06:43

    Hi Stephanie,

    Thank you for your clear explanation; this is very helpful. Question though regarding triage calls. If the nurse takes the initial call then discusses and gathers direction from the provider can the nurse then bill regarding the call? I work in a pulmonary office so these are not new diagnoses when patients call but more chronic conditions.

    Debbie



    ------------------------------
    Debra Washko RN
    Practice RN
    Northwell Health
    Huntingtn Sta NY
    (775)240-6126
    ------------------------------



  • 9.  RE: Nurse billing with cpt 99211

    Posted 06-04-2023 15:20
    This could be a bit of a gray area and perhaps your institutional compliance would best provide definitive guidance... however here are some thoughts.  Are you providing a service to the patient or are you relaying information from the provider about their plan?  You have to be providing a billable service that the patient needs and that the provider has previously diagnosed and seen the patient for.  In a pulmonology practice if the patient has new congestion or other new problem, you wouldn't be able to bill as the provider would not have previously seen the patient for this problem.  If the patient has COPD and has seen the provider previously for that, the provider could potentially order education for the patient which may be billable    If so, this education/counseling must be substantive and documented to support a bill.  

    Also - although the PHE is no longer in effect telehealth was carved out until the end of 2024.  In other words, virtual visits are still reimbursable until then.  After this date it is possible that the billing guidelines for RNs and other clinical staff will revert back to in-person only.  

    Triage is hard, as generally these are new or exacerbating problems and you are providing advice to a patient rather than a billable service.

    Stephanie

    Stephanie G Witwer, Ph.D., RN, NEA-BC, FAAN
    Department of Nursing
    Emeritus Staff





  • 10.  RE: Nurse billing with cpt 99211

    Posted 06-05-2023 10:25
    Thank you all for your responses to the nurse billing question. I learned from your responses and found it helpful to the practice I am working with.





  • 11.  RE: Nurse billing with cpt 99211

    Posted 06-04-2023 21:19

    One more comment -I don't believe that telephonic encounters with clinical staff are billable at this time.  They must be a virtual visit.  Sorry I did not include that earlier.

    Stephanie



    ------------------------------
    Stephanie Witwer PhD RN NEA-BC FAAN
    Emeritus Staff
    Mayo Clinic
    Pine Island MN
    (701)240-6208
    ------------------------------



  • 12.  RE: Nurse billing with cpt 99211

    Posted 06-06-2023 10:02

    We place it under nurse visit. I am not sure how it is billed on the back end but we do charge it in Epic that way. We also have started charging for extended triage needs or follow up. This process is new and we are still working out the kinks but we do charge for extended phone call time with a patient. 



    ------------------------------
    Isabel Sanchez
    BSN
    UChealth Medical Group
    Colorado Springs CO
    (719)364-3688
    ------------------------------



  • 13.  RE: Nurse billing with cpt 99211

    Posted 06-07-2023 11:37

    I would love to join this conversation. My billing team states that telephone triage can not be billed using codes 98966- 98968 as these codes are only for Registered Dieticians, Social Workers, Speech Therapists, PT & OT.

    There is so much value to the organization, the patient, and the healthcare industry with Nurse Triage, but without it being billable leaves some to not pursue or not see the value to the organization.



    ------------------------------
    Dotty Parker
    Director Nursing- Ambulatory Clinical Quality
    Montage Medical Group
    Salinas CA
    (831)265-3989
    ------------------------------



  • 14.  RE: Nurse billing with cpt 99211

    Posted 06-07-2023 12:08

    Hello,

    I did some research on the codes that you mentioned.  Here is what CMS states:

      "During the COVID-19 PHE, non-physician practitioners who are eligible to bill Medicare directly, including registered dietitians and nutrition professionals, may bill for audio-only telephone assessment and management services".  Despite the end of the PHE, leniency for billing for telehealth services has been extended through 2024.  After that it will be uncertain.

    The key phrase is "practitioners who are eligible to bill Medicare directly".  This does not include RNs as our license does not allow independent diagnosis and treatment.



    ------------------------------
    Stephanie Witwer PhD RN NEA-BC FAAN
    Emeritus Staff
    Mayo Clinic
    Pine Island MN
    (701)240-6208
    ------------------------------



  • 15.  RE: Nurse billing with cpt 99211

    Posted 06-07-2023 13:14
    I want to clarify that the triage time (phone time) is billable by NP, PA, or provider. This is in relation to my previous comment of charging for phone time.  It is not being billed for nurses. 
    Sorry just want to make sure I stated that. 

    Issie Sanchez BSN, RN

     

    Dublin Primary Care

    2685 Dublin BLVD.

    Colorado Springs, CO 80918
    O
     719.364.3688

    isabel.sanchez@uchealth.org







  • 16.  RE: Nurse billing with cpt 99211

    Posted 06-07-2023 14:09
    The problem identified from the group is that nursing leadership has not been typically involved in billing and therefore is not in a position to advocate for a billing structure that is user friendly or compatible with nursing care delivery.

    This is a problem that will not be resolved by the profession waiting to be recognized.

    Those who have access to billing departments and coding personnel within their organizations should research the billing codes used by other profession, identify those that can be uniquely related to specific nursing services, and advocate for the profession by associating the codes used "retrospectively" with specific patient outcomes.  This would make a great research study and the data collected from across the country would provide a good database for further developing nurse sensitive indicators as well as information to take to CMS to argue for policy change. 

    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

    Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]

    Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute 

    Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing


    Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084 

    T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229 

    mobley@rowan.edu | som.rowan.edu 


    Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].





  • 17.  RE: Nurse billing with cpt 99211

    Posted 06-11-2023 22:06

    Do any of your practices do Chronic Care or Principal Care Management services? IF they do the time spent with the clinical staff is billable under the CCM or PCM service guidelines. We are just really jumping into the CCM services world and it has some requirements for patients to participate the the care between OV is billable under the general supervision of the provider. 



    ------------------------------
    Addie Lowe MSN RN
    Covenant Medical Group
    Kingstree SC
    (843)372-2334
    ------------------------------