Wiki - Can a nurse bill a 99213 ?? (2024)

FAQs

Can you bill a 99213 for a nurse visit? ›

The 99213 code is used by a wide range of healthcare professionals, including physicians, nurse practitioners, and physician assistants. It is typically used for office visits that require a moderate level of medical decision-making and complexity.

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.

The code 99211 is the only E/M CPT code that allows RNs and clinical staff to bill for direct services without the presence of a QHP. This code is defined as an “office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician” (AMA, 2021, p.

CPT code 99211 is often called the nurse visit code. But it's not just for nurses! Many of your practice employees can provide the service. They must be qualified to evaluate and meet the patient's care needs in a limited capacity.

However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.

If the circ*mstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with psychological testing (such as CPT code 96101), modifier 59 would be appended to the testing code.

The face-to-face time with the physician is 22 min and the code billed is 99213 (less than the minutes currently typical for 99214 and within the 20–29 min designated for 2021). These telemedicine visits will require documentation similar to in-person visits.

General E/M Code Procedure:

New patient E/M codes 99202- 99205 and established patient E/M codes 99211-99215 don't state 'per day' in their descriptors, but payer rules may prevent you from reporting more than one E/M code for a single patient on the same date of service.

Many nursing units have policies in place that can be intimidating and act as a punishment for nurses who call in sick. Some policies include: Calling in sick during a weekend shift means you are mandated to makeup another weekend shift chosen by the nurse manager.

Can a nurse practitioner bill for home visits? ›

Services for Which an NP Can Bill Medicare

Part A covers hospitalization, skilled nursing facility services, and some home health services. Part B covers physician services, outpatient hospital services, laboratory procedures, medical equipment, and some home health expenses.

Unlike the U.S. Bill of Rights found in the Constitution, the Nurses Bill of Rights is not incorporated into the law. Rather, it's a document created by the American Nurses Association (ANA) that outlines professional standards and serves as a guide for employers, policymakers, contract agencies, and nurses.

This happens frequently when a patient returns for follow-up care and the pathology report is discussed. If the discussion turns into a 15- or 25-minute visit, the visit could be billed a 99213 or 99214 based on “time spent.” Obviously, the time must be clearly documented in the chart.

Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter.

For example, if the total duration of face-to-face physician-patient time is 21 minutes, select code 99214 because the duration of visit is closer to 25 minutes, the average time for a 99214, than it is to 15 minutes, the average time for a 99213.

In most cases, the visit would be a level one new patient visit (99201), level two established patient visit (99212), or nurse visit (99211), since only one body area is examined, and the history and/or medical decision-making are straightforward.

The face-to-face time with the physician is 22 min and the code billed is 99213 (less than the minutes currently typical for 99214 and within the 20–29 min designated for 2021). These telemedicine visits will require documentation similar to in-person visits.

In a typical 99213 visit, you may not need to review or update the patient's PFSH at all, but a 99214 requires at least one of those areas be reviewed and documented.

This Comparative Billing Report (CBR) focuses on physicians who submit claims for New Patient Office Visit (E/M) Services (CPT® codes 99201–99205).