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RE: [CCO-L] SNF - Initial visits by NP or PA

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  • Quinten Buechner
    But see http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm10 4c12.pdf Quinten A. Buechner, M.S., M.Div., ACS-FP/GI/PEDS(BAMC),
    Message 1 of 10 , Feb 23 10:58 AM
    • 0 Attachment
      But see
      http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm10
      4c12.pdf



      Quinten A. Buechner, M.S., M.Div.,
      ACS-FP/GI/PEDS(BAMC), CPC(AAPC), CCP(PHIA), CMSC(PAHCS)

      President and CEO

      ProActive Consultants, LLC

      1659 3rd Ave, Cumberland, WI 54829

      E-mail: QuinB@...

      Phone: 715.822.8284

      Cell: 715.307.4448

      Fax: 715.822.8299



      From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of
      Kergides, Jo Ann
      Sent: Friday, February 15, 2013 7:10 AM
      To: CCO-L@yahoogroups.com
      Subject: RE: [CCO-L] SNF - Initial visits by NP or PA





      Our local carrier Novitas Solutions had an inservice on "Nursing Facility
      E&M Services" and the handout clearly states that NPs can only report subq
      visits codes. I'm not sure where you're located. Maybe you should invite
      your local carrier for a similar presentation.

      Jo Ann F Kergides, CPC-H
      Coding Specialist
      UMDNJ-SOM NJ Institute for Successful Aging
      42 E Laurel Rd, UDP #1800
      Stratford, NJ 08084
      Phone: 856-566-6833
      Fax: 856-566-7089

      This messeage is intended for the use of the person or entity to which it is
      addressed and may contain information that is privileged and confidential,
      the disclosure of which is governed by applicable law. If the reader of this
      message is not the intended recipient, or the employee or agent responsible
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      From: CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com>
      [mailto:CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> ] On Behalf
      Of mrl
      Sent: Thursday, February 14, 2013 7:00 PM
      To: CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com>
      Subject: Re: [CCO-L] SNF - Initial visits by NP or PA

      TO: Jo Ann F Kergides, CPC-H

      Please explain your answer. A statement does not an answer make. Where
      is your documentation to backup your statement? Coding Clinic ? CMS memo?

      On 14 February 2013 12:57, Ericadschwalm EricaDSchwalm@...
      <mailto:EricaDSchwalm%40aol.com> > wrote:

      > **
      >
      >
      >
      > Also, CR 7405 from Aug 2011 -
      >
      > The general policy of billing the most appropriate visit code, following
      > the elimination of payments for consultation codes, shall also apply to
      > billing initial visits provided in skilled nursing facilities (SNFs) and
      > nursing facilities (NFs) by physicians and nonphysician practitioners
      > (NPPs) who are not providing the federally mandated initial visit. If a
      > physician or NPP is furnishing that practitioner's first E/M service for a
      > Medicare beneficiary in a SNF or NF during the patient's facility stay,
      > even if that service is provided prior to the federally mandated visit,
      the
      > practitioner may bill the most appropriate E/M code that reflects the
      > services the practitioner furnished, whether that code be an initial
      > nursing facility care code (CPT codes 99304-99306) or a subsequent nursing
      > facility care code (CPT codes 99307-99310) when documentation and medical
      > necessity do not meet the requirements for billing an initial nursing
      > facility care code.
      >
      > -----Original Message-----
      > From: Ericadschwalm EricaDSchwalm@... <mailto:EricaDSchwalm%40aol.com>
      >
      > To: CCO-L CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> >
      > Sent: Thu, Feb 14, 2013 3:49 pm
      > Subject: Re: [CCO-L] SNF - Initial visits by NP or PA
      >
      > Please explain why the guidelines below state otherwise? Thanks so much!
      >
      > -----Original Message-----
      > From: Kergides, Jo Ann kergidjf@... <mailto:kergidjf%40umdnj.edu> >
      > To: CCO-L CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> >
      > Sent: Thu, Feb 14, 2013 3:23 pm
      > Subject: RE: [CCO-L] SNF - Initial visits by NP or PA
      >
      > NPs cannot bill initial visits in a facility.
      >
      > Jo Ann F Kergides, CPC-H
      > Coding Specialist
      > UMDNJ-SOM NJ Institute for Successful Aging
      > 42 E Laurel Rd, UDP #1800
      > Stratford, NJ 08084
      > Phone: 856-566-6833
      > Fax: 856-566-7089
      >
      > This messeage is intended for the use of the person or entity to which it
      > is addressed and may contain information that is privileged and
      > confidential, the disclosure of which is governed by applicable law. If
      the
      > reader of this message is not the intended recipient, or the employee or
      > agent responsible to deliver it to the intended recipient, you are hereby
      > notified that any dissemination, distribution or copying of this
      > information is STRICTLY PROHIBITED. If you have received this message in
      > error, please notify the sender immediately and arrange for the return or
      > destruction of these documents.
      >
      > From: CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com>
      [mailto:CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> ] On Behalf
      Of
      > Ericadschwalm
      > Sent: Thursday, February 14, 2013 3:12 PM
      > To: coding@... <mailto:coding%40lyris.aafp.org> ;
      cco-l@yahoogroups.com <mailto:cco-l%40yahoogroups.com> ;
      > ericacodes@yahoogroups.com <mailto:ericacodes%40yahoogroups.com>
      > Subject: [CCO-L] SNF - Initial visits by NP or PA
      >
      > Hello,
      >
      > I understand that in previous years an NPP could not bill for the initial
      > SNF visit (e.g. 99306).
      >
      > However the current guidelines I'm reading state differently (see below).
      >
      > Somehow had missed that change in 2010, saw it recently and started
      > billing the initials (previously we would change a 99306 tp 99310 when
      done
      > by a midlevel).
      >
      > But now Medicare NHIC is denying our claims (e.g. 99306) when billed under
      > an NP's name. "Service is not covered by this type of provider".
      >
      > I'm totally confused! Am I understanding these guidelines wrong or is
      > Medicare wrong!?!? Anyone else have this issue?
      >
      > "The Centers for Medicare & Medicaid Services (CMS) would like to remind
      > skilled nursing facilities (SNFs) and nursing facilities (NFs) of the
      > evaluation and management (E/M) services coding policy that has been in
      > effect since January 1, 2010. If a physician or non-physician practitioner
      > is furnishing that practitioner"s first E/M service for a Medicare
      > beneficiary in a SNF or NF during the patient"s facility stay, even if
      that
      > service is provided prior to the federally mandated visit, the
      practitioner
      > may bill the most appropriate E/M code that reflects the services the
      > practitioner furnished, whether that code be an initial nursing facility
      > care code (CPT codes 99304 - 99306) or a subsequent nursing facility care
      > code (CPT codes 99307 - 99310) if documentation and medical necessity do
      > not meet the requirements for billing an initial nursing facility care
      > code. "
      >
      > and
      >
      > "A NPP may perform medically necessary E/M visits prior to and after the
      > initial visit if all the requirements for collaboration, general physician
      > supervision, licensure and billing are met. Payment is made for E/M visits
      > to patients in a SNF who are receiving services for medically complex care
      > upon discharge from an acute care facility when the visits are reasonable
      > and medically necessary and documented in the medical record. Physicians
      > and NPPs shall report initial nursing facility care codes for their first
      > visit with the patient. "
      >
      >
      >
      http://www.medicarenhic.com/providers/pubs/REF-EDO-0020%20PA%20NP%20CNS%20CN
      M%20Billing%20Guide.pdf
      >
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