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Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

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February 5, 2023

Non-physician practitioners in nursing facilities

Find additional information about nursing facility services in Betsy’s signature resource Everyday Coding.

Question:

Can a physician assistant see patients in a nursing facility without a physician signing each encounter? How do we bill this? Can we do wellness visits in a nursing facility?

Answer:

  • A physician assistant or an advanced practice registered nurse  may see patients independently in a nursing facility but must bill under their own provider number. Beginning 1-1-2022, visits that are not mandated as physician services may be reported as shared services between a physician and a non-physician practitioner.
  • Mandated visits: Only a physician may bill the initial nursing facility visits 99304-99306 in a skilled nursing facility or nursing facility.  (There is an exception to this in a nursing facility who is not employed by the facility). Sometimes, the PA/NP sees the patient at an earlier date than the physician, who comes and does the admission. In that case, the PA/NP bills a subsequent visit, even though the initial has not been billed. This is a Medicare rule.
  • I am not aware of any restrictions against billing wellness visits in the nursing facility, provided it is appropriate to do a preventive plan for the patient.

Here  is a link to the MedLearn matters article. It discusses frequency of mandated physician visits.

 

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CPT is a registered trademark of the American Medical Association Copyright 2019, American Medical Association All rights reserved.

Last revised July 28, 2022 - Betsy Nicoletti
Tags: medicare incident-to and shared services

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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