Process nurse visits, phone services properly

Q: Our nurse responds to patient inquiries made via telephone to fax in prescription refills to a pharmacy, answer a question about a medication, or provide advice based on symptoms. And sometimes patients come to the office to ask for medication samples. Can these types of services be billed?

There are no specific history, exam, or medical decision-making requirements for 99211. The note needs documentation of the reason for the encounter and a description of the service rendered. It also should include the date of service, the identity of the nurse providing the service, and any verbal interaction with the physician, whose identity also should be noted.

Medicare further interprets the physician telephone service codes in Pub. 100–04 Transmittal 1423, stating that although Medicare does not pay separately for physician or nonphysician telephone conversations with patients or their families, the physician may consider these conversations when determining which level of E/M code to assign on the next claim for a face-to-face E/M visit. Codes meeting this criteria are bundled under the Medicare physician fee schedule. Medicare's position is that, although these new codes are "non-covered," many phone calls to patients remain "bundled." It's important to get this right, because the answer will determine whether you can bill the patient.

Many commercial payers also are not reimbursing for telephone services, so you should check with your area's payers before billing. If a payer is reimbursing for these services, then a nurse can bill 98966–98968 if:

The author is a compliance manager for Baptist Medical Associates in Louisville, Kentucky. Have a coding or managed care question for our experts? Send it to meletters@advanstar.com
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