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Nurse practitioner and X-rays

I’m a new biller, working at a new urgent care clinic. We have 2 nurse practitioners who have been administering and reading x-rays. Our doctors who are supervising (but not actually in the building), our NPs, and our office manager all believe that the NPs are able to read the x-rays. However, insurance is denying payment, stating the x-ray codes are beyond the provider’s scope of practice. Any advice on a solution? Eventually, we will have a contract signed with an outside company who will be reading the x-rays. In this case, do we bill the x-ray code with TC modifier? (And the other company uses -26? or vice-versa?) What about a way to get our current x-rays paid for? Please provide quotes or links I can use for reference, if possible, so I can pass on the info. Thanks!

Medical Billing and Coding Forum

Nurse Practitioner Billing

I am relatively new to billing and am struggling with this issue.

I work in an integrated physician’s office; we primarily perform chiropractic services but also currently have a Family Practice D.O. who performs H&P, Hyalgan injections, tendon injections, TPI, NCV/EMG, DME, allergy testing and shots, etc.

Our D.O. is retiring and a Nurse Practitioner will be taking his place. She will have a collaborating physician who will not be working in our office. The office manager and I have no idea how to bill for her.

We have no idea whose NPI to use and where on the HCFA form, if SA modifier is needed, etc.

I apologize in advance for my utter ignorance as I am primarily a coder.

Thank you SO MUCH for any help you can give me on this!

judi

Medical Billing and Coding Forum

Donna Peery CPC-A / Registered Nurse

Donna J. Peery
CPC-A / R.N. B.S.N.
P.O. Box 1339 Bridge City, Texas 77611
409.749.4235 [email protected]

Certified Professional Coder (CPC-A) seeking a professional coding position utilizing my expertise and knowledge of nursing and medical procedures, healthcare administration policies, quality assurance and regulatory compliance. Self- directed professional, detailed oriented and dedicated to excel professionally and personally. Successful in managing time and prioritizing tasks.


CODING SKILLS:
• Out-Patient & In-Patient Coding
• ICD-10-CM, ICD-10-PCS
• CPT/HCPCS Level II
• Health Information Management
• CMS 1500 and UB-04 Claim Forms
• Healthcare Reimbursement
• Medical Terminology & Anatomy
• Pharmacology & Pathophysiology
• 3M Encoder / 3M Reference Software
• Knowledge of HIPAA/ Pt.Confidentiality
• Detailed Knowledge of Coding Guidelines
• APC and MS-DRG Assignments
• Clinical Data Analysis and Abstraction


EDUCATION:
Certification: CPC-A /AAPC (One year experience) 5/5/2018

Professional Medical Coding and Billing / Career Step 1/30/2018

Certificate of Graduation with Honors
• Coded over 250 outpatient reports and inpatient records.
• Types of reports coded include: Consultations, Emergency Room reports, History and Physical reports, Laboratory reports, Operative reports, Physician Orders, Procedure Notes, Progress Notes, Radiology reports, and Pathology reports.
• Coded reports in the following specialties: E/M , Anesthesia, Pathology, Psychiatric, General Surgery, Radiology, Gastroenterology, Dermatology, Urology, ENT, Infectious Diseases, Respiratory, Cardiology, Internal Medicine,
Neurology, Neurosurgery, Plastic Surgery, Oncology, Orthopedics, OB/GYN, Trauma,etc.
• ICD-10-CM and ICD-10-PCS coursework (635+hours) ICD-10 coding code set training.
• Familiarity with the AHA ICD-10-CM and ICD-10-PCS Coding Handbook.
• Extensive training in the biomedical sciences—medical terminology, advanced anatomy, pathophysiology, physiology, and pharmacology.
• Training in HIPAA and HIM reimbursement processes (CMS-1500 and UB-04 (5010) claim forms, MS-DRGs.

Lamar University Beaumont, Texas
Bachelor of Science Degree in Nursing (B.S.N. R.N.)
Associate of Science Degree in Nursing (A.D. R.N.)

Orange Memorial Hospital Orange, Texas
Certified Laboratory Assistant School – Diploma Awarded Medical Technologist
American Medical Technologist (AMT)

PROFESSIONAL EXPERIENCE:
Gentiva Odyssey Hospice – Beaumont, Texas
Volunteer 3/2014-3/2016
• Conduct home and facility visits to administer patient care plans as a member of an interdisciplinary team of
healthcare providers and social services professionals.
• Employ assessment, intervention, and nursing skills to identify and coordinate patient/family needs and maximize patient comfort and to enhance the quality of life to the patient/family unit.

Leave of Absence
• Attended to family member medical issues. 5/2012-3/2017

Portamedic – Houston, Texas
Paramedical Examiner (Independent Contractor) 1/2011–5/2012
•Conducted field paramedical examinations for life, health, disability, and long-term care policies.

Christus Health St. Elizabeth -Beaumont, Texas
Outpatient Surgery and Pain Management / Staff R.N. 9/2009–11/2010
• Provided pre- and post-operative care for a diverse patient population.
• Continuously monitored patients in post-operation; handled pain management; and provided patient and family education.

Medical Center of Southeast Texas – Port Arthur, Texas
Emergency Room / Staff R.N. 10/2008 – 9/2009
• Assessed, intervened and stabilized a variety of trauma and illnesses with decisive action.
• Maintained compliance with hospital protocols, procedures, quality, and safety policies.

GreenTree Administrators – Beaumont, Texas
RN Case Manager 11/2007 – 10/2008
• Conducted utilization review, pre-certification, and managed insured members in Disease Management and large case Management programs for a third party administrator.
• Provided education, directed patients to in-network providers for managed care, and assisted with claims management.
• Performed hospital and in-home visits for assessment, plan of care, and patient education.

Physician’s Cardiovascular Diagnostic Center – Beaumont, Texas
Staff RN/Quality Coordinator 6/2000 – 11/2007
• Provided pre, intra, and post operative patient care and evaluation.
• Created and managed Quality Program to ensure compliance of all company policies and procedures, and state, federal, nursing and OSHA regulations.
• Analyzed quality assurance data including statistics, customer satisfaction, clinical pertinence, utilization review, and incident reporting of compliance and operational benchmarking targets.
• Active role in Facility’s preparation of first successful Joint Commission Accreditation

EARLY CAREER
Development Manager for new Cardiac Rehabilitation Program, Cardiac Rehabilitation Manager, Medical Auditor, Cath. Lab Charge Nurse, Emergency Room R.N., and Intensive Care R.N.
• Career Portfolio available upon request

Medical Billing and Coding Forum

Help! Nurse practioners and xrays incident to?

FOR MEDICARE ONLY….WHAT MODIFIER TO WE PUT ON XRAYS DONE IN THE OFFICE WHEN BILLING UNDER A NURSE PRACTIONER, NOT INCIDENT TO? 26 OR TC?? WE HAVE BEEN PUTTING TC ON THE XRAYS WHEN BILLING OUR NURSE PRACTIONERS AS THEMSELVES BUT FOUND SOMETHING THAT SAID IT SHOULD BE 26? I THOUGHT THAT WAS ONLY FOR IF THE DOCTOR READ IT…..NOW WE ARE NOT SURE. JUST WANT TO GET IT CORRECT. PLEASE ADVISE WITH ARTICLES IF YOU CAN. :confused:

Medical Billing and Coding Forum

Nurse visit for an Immunization

Hello..

I have a nurse visit where an immunization was the only thing done. There were no vitals documented, only the documentation of the immunization. How would you code this? I used 90471 plus the vaccine administered. However, a person in my billing department wants me to put E/M of 99211. Would that be appropriate? Thanks 😎

Medical Billing and Coding Forum

Nurse visit for a TB test administered

Hello..

I have a nurse visit where a TB test was the only thing done. There were no vitals documented, only the documentation of the TB test being given with instructions to come back 2 days later for the test to be read. How would you code this? A person in my billing department wants me to put E/M of 99211. Would that be appropriate? Thanks

Medical Billing and Coding Forum

CPT 98960 Nurse Education

This question is in regards to a pain management clinic which prescribed long term narcotics. For each pain management patients, the RN meets with the patient to discuss narcotic use, ways to avoid overdoses, signs of overdose, prevention, what to do in case of an overdose. We have been coding as 98960 which is consistently being denied. What CPT code should be used for non physician self management education? This visit is separate from the patients normal monthly office visit.

Medical Billing and Coding Forum

Nurse visit for medication management,looking for direction

Hoping somene can help
When patients are prescribed high risk medication such as suboxone,fentanyl,or other opiates it is common practice to have those pt come in for random pill counts,presumptive urine test and or send out urine.
Typically a lot of of work goes into the visit such as supervision of sample given(suboxne pt) reviewing med list for compliance,updating Narcotic agreements by confirming or updating pharmacy information, reviweing results of urine test with Provider and queing presciption to provider (MDM),documenting patients responce to medication,such as breakthrough pain,or symptoms of withdrawal. The Nurse visits are scheulded inbetween visits with the Proivder ,which I feel is an extensin of the Providers care ,perhpas even an "Incident To"
Currently we only use the lab code 80305 for the urine as the office manager feels that is all that should be coded.When I look at the critera for 99211 I honestly feel these Nurse visits should be more than just the presumptve lab and feel we could use both the 99211 and the 80305(wen performed)however I’m new at coding and a little reluctant to rock the boat without knowing for sure
Very much appreciate help from those in the know

Medical Billing and Coding Forum