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Nurse Practictitioner Home Care

Ramona Posted Fri 19th of April, 2013 20:47:46 PM

I am currently working with a Nurse Practitioner who does home care. I am clear on which CPT codes to use with modifer SA but I am not sure what address to use for service location I am using POS code 12 Home.

Home care is new to me so any help would be appreciated


SuperCoder Answered Mon 22nd of April, 2013 14:31:38 PM

We are working on this and will get back soon.


SuperCoder Answered Tue 23rd of April, 2013 05:09:03 AM

SA is a HCPCS modifier code that indicates a nurse practitioner has rendered services in collaboration with a physician. Reimbursement may be reduced for some related services subject to this industry standard edit (e.g. venipuncture, urinalysis) due to editing changes in coding relationships, such as bundling/unbundling, codes incidental to global payments, and codes in conflict with a patient’s age/gender.

Some provider types may submit claims for which an advanced practice nurse (APN) is the rendering provider. The procedure code for any service provided by an APN (except laboratory procedures and any take-home durable medical equipment, supplies and orthotic/prosthetic items) must be accompanied by the appropriate
modifier (SA, SB or UC).

I do not see any option other than 12 here. I will definitely share with you if i found something evident regarding this POS.

SuperCoder Answered Wed 24th of April, 2013 20:54:21 PM


Which form locator are you talking about?

Ramona Posted Tue 30th of April, 2013 18:48:43 PM

In response to your question I do not understand what you mean by form locator...but I sent claims to Medicare with CPT 99347 with modifer SA and they were denied as "invalid procedure code modifer for services rendered" I am not sure what the problem is and cannot find the information in need on the Medicare website.

SuperCoder Answered Wed 01st of May, 2013 12:55:40 PM

I am submitting a Q/A from our alert.Hope this benefits.

Question: Our doctor made a house call, so our claim will go with code 99347 and POS 12. I have to set up our IDX location with a hard-coded address. The question is, what address is appropriate -- our normal office address or the patient's address?

Answer: You should leave that field blank. The home address is already on the claim, so you don't have to repeat it. You should never use the address on a POS 12 (Home) claim.

Noridian, which is a Medicare carrier that covers the Western United States, explains this on in its CMS-1500 Claim Form Instructions in these words about Item 32 on the CMS-1500 form:

-Enter the name, address, and zip code of the facility if the services were furnished in a hospital, clinic, laboratory, or facility other than the patient's home or physician's office. Effective for claims received on or after April 1, 2004, ... the name, address, and zip code of the service location are needed for all services other than those furnished in place of service home -- 12.-

CPT guidance: Private residences don't count as a facility. When a physician provides E/M services to a patient in his own private residence and you report POS 12 and not any type of facility on the claim, you should use the home service codes 99341-99350 (Home visit for the evaluation and management ...), according to CMS rules. So even if a patient is -at home- in the domiciliary or rest home, you would not use 99341-99350.

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