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nurse visit for cath. change

Teresa Posted Wed 11th of February, 2015 14:22:10 PM

we recently had a patient in for a cath. change (51702) which the nurse proceede to do and normally we bill this charge (99211) under the doctor in the office; however in this instance the nursing note refers to a doctor who was not in the office on the date of the procedure....the note read patient presents to office for routine foley catheter change per Dr. X......and then goes into detail of what was done....I guess is this a billable service under Dr. X if he is not in the office...and if not and the note states Dr. X's name can we bill under the PA or NP that is in the office on that date?

Teresa Posted Wed 11th of February, 2015 14:26:47 PM

I need to make an addendum to my previous post...we are not billing the 99211, but rather the 51702, but the rest still applies as far as the physician not being in office, etc.

SuperCoder Answered Thu 12th of February, 2015 09:22:48 AM

Thanks for your question. The doctor must be on site in order to bill services under their NPI. Even though the doctor ordered the catheter change, you can bill under the provider that was actually in the building at the time of the service. "Incident to" requirements must be met to bill. See the attached Medicare document outlining "incident to" guidelines. Hope this helps.

http://www.wpsmedicare.com/j8macpartb/training/on_demand/_files/2013-0723-incident-to-services-handout.pdf

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