Can an RN bill for E/M services higher than a level 1 (99211)?

Question

I am hoping that there is coder out there that can help me with this. I have an RN that is billing 99215 can that happen

Answer 1

Well, different codes allow offices to charge different amounts. I believe that codes for Office/Outpatient E/M Visits are between 99201-99215. So yes, you can have 99215 for a service. However, a code of 99215 tells you that "Usually, the presenting problems are of moderate to high severity." Although high complexity medical decision making isn't required, it's reasonable to conclude that this level of service may be questioned if it's not present. So if you don't think this service required any degree of complexity, you may want to call the office's billing department and ask for an explanation. If they did make a mistake, they may even just take off the charge completely. Hope this helps.

Answer 2

"All personnel, other than physicians and qualified NPPs, who provide E&M services incident to a physician’s service are limited to a 99211, according to MCM section 15501.1"

This is per this link:
http://www.codingandreimbursement.net/forums/showthread.php?t=3495

Not the best source to prove this, but I can't find the CPT manual online.

The AAFP puts out good articles, such as:
http://www.aafp.org/fpm/20000700/39codi.html#box_b

Which, of course, states that a physician need not be present for a level 1...and is almost exclusively used for a nursing only visit. This, of course, implies that the physician must be present for at least part of the visit to code above level 1 (and, generally speaking, a physician should almost never bill a level 1).

Of course, a NP (Nurse Practioner) and a PA (Physician Assistant) CAN code levels above 2...up to level 5. These are the NPPs (non-physician practioners).

Check a CPT Manual for non-physician services...