Tip from Carolyn Buppert: Can NPs Bill for Patient Teaching?

How can an APN, MD or PA bill patient teaching?

When a clinician spends more than half of a face-to-face visit with a patient counseling the patient, the clinician may bill an evaluation and management code, based on the time spent. Counseling includes medically necessary discussion about

• Lab results, prognosis, or treatment options
• Instructions for treatment
• Importance of compliance and
• Reduction of risk factors.

For example, a NP spends 40 minutes with the patient in the office and 22 minutes of that is discussing lab results and treatment options. The NP may bill the highest level office visit. Consult the current edition of Current Procedural Terminology (CPT) for the times that correspond with the codes.

Documentation must include the time spent (total and on counseling), the necessity for the discussion and a brief summary of what was discussed. The clinician would document history, examination and medical decision-making as well, if performed, but it is the time spent that determines the choice of code when billing a counseling visit.

This tip is excerpted from Billing Physician Services Provided by Nurse Practitioners (2013), a booklet available from the Law Office of Carolyn Buppert. For more information on legal issues affecting nurse practitioners and their employers, visit http://www.buppert.com