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* Billing for nutritional counseling after surgery
* Insurers, physicians, and business associate agreements
* Pay-per-view article: Compliance is more than Medicare fraud

Compliance Monitor, April 18, 2003

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Billing for nutritional counseling after surgery

Q: Our physician performs gastric bypass surgeries. His patients often follow up with the medical assistant for counseling and B12 injections. I want to bill for these services, as we see many of these patients. The code I was thinking about using is 99211. But can I bill for a nursing assistant to see a patient for nutritional counseling if the physician is in the office? Does the physician have to see the patient in this case?

A: If your state Physician Practice Act allows your physicians to delegate services to non-licensed personnel, your nurse assistants may perform these two services (counseling and B12 injections), and bill them as 'incident to' the physician's services. You will find the 'incident to' requirements described in section §2050 of the Medicare Carrier Manual. To meet the criteria, your physician must establish a patient treatment plan, be in the office suite when non-physician personnel see the patient, and be involved in care frequently enough to establish ongoing care.

CPT code 99211 is an evaluation and management code and, by definition, does not require the presence of the physician. Appendix C of the American Medical Association's 2003 CPT offers this example of a 99211: "Office visit for an 82-year-old female, established patient, for a monthly B12 injection with documented Vitamin B12 deficiency."

You should also consider whether the services are part of the global surgical package. Normal follow up care is included in payment for the surgery itself, so if these services are provided within 90 days of the gastric bypass, no separate billing should occur. If, however, dietary advice continues beyond the global period, and all other conditions are met, billing a 99211 may be appropriate.

This question was answered by Charla Prillman, CPC, CHCO, senior associate, PricewaterhouseCoopers, LLP.

Go to "Compliance is more than Medicare fraud" for the rest of this article. The cost is $10. Subscribers to the online version of Strategies for Health Care Compliance have free access to this article. Subscribers to the print edition can find it in their April issues.

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You can read this article-and much more-in the entire April issue of Strategies for Health Care Compliance. Your cost: Five stories for only $30! You'll learn the details of Janet Rehnquist's resignation, and get an inside look at CMS' outlier investigation. Choose between a PDF or HTML version for just $30. Online subscribers have free access to this issue. Print newsletter subscribers can find it in their mailboxes.

Q:Should I be calling all of the insurance companies with which we we contract to establish business associate agreements under the Health Insurance Portability and Accountability Act (HIPAA)? I have been calling them, and they do not know what I am talking about.

A: No, you do not need to call a health plan to request a business associate agreement. Generally, business associate agreements are not necessary between a physician's office and a health plan in which the physician is a participating provider. There is already an existing contractual agreement between these covered entities. They both fall under the treatment, payment, and health care operations provision of HIPAA.

However, both your office and your insurers are required to provide each patient with a notice of privacy practice, starting April 14, 2003.

This question was answered by Claudia M. Davis, RN, LHRM, LNC, of Risk Reducers, Inc. in Spring Hill, FL.

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