Incident to CPT Codes for Consultant Pharmacists (2018)

How can a consultant pharmacists utilize
incident to billing codes in an ambulatory care clinic? Find out next! Hi I’m Blair Thielemier and I work with
pharmacists who want to build and grow their clinical consulting based
businesses. In this introduction to incident to billing, we are going to talk
about the 99211-99214 codes and opportunities for consultant pharmacists
to utilize them in their practice settings. So first thing to remember, the
incident to billing codes obviously are beholden to incident to billing criteria
requirements. If you want to review the incident to billing requirements go back
and check out our incident to vs. general supervision video. So this means
that the 99211-99214 incident to billing codes can be
billed through the physicians NPI by an auxiliary provider or a non physician
provider under the same roof, under the direct supervision of a physician. What
is important to remember about these codes, is they are billed at 100% the
Medicare physician fee schedule and they must be provided in a face-to-face
encounter with the patient. Now many pharmacists complained because
they are required to only bill for the 99211,
which is considered a nurse’s visit. Certain MAC’s have stated that
pharmacists can bill for higher codes in the incident to billing structure and
may bill for anything up to 99214 is what pharmacists are
telling me that they’re seeing in practice. So the 99214 is a moderate level of medical decision making. It’s 25 minutes
of face-to-face time spent with a patient on counseling, on care
coordination or whatever it is the consultant pharmacist has the patient
has been referred to them for. Versus the 99211 visit may only be five minutes no
medical decision-making is required and it doesn’t pay near as much as the other.
I still want to encourage everyone to check with your local MAC and check with
your state scope of practice act for pharmacists services, to be sure that you
can bill at higher levels using these incident to codes. And remember the
American Academy of Family Physicians estimates that only five 99211 visits
each week for Medicare patients could result in over $5,000 a year in
additional revenue for the practice. So it is, if something is just being handled
in a very brief way, it is something that the pharmacists are able to bill for
that brief encounter, under the physician’s direct supervision. In
summary, the 99211-99214 for incident to billing codes can be
provided by an auxiliary staff member, a clinical consultant pharmacist under the
direct supervision of a collaborative physician in an office setting for their
patients. The referral might look something
like: the physician sees the patient one day, they feel like the
patient needs follow-up for say a genetic testing session or counseling on
diabetic management or even just a medication reconciliation with the
pharmacist, they will then refer that patient to the pharmacist, the
pharmacists will bring them in on their own, see the patient and be able to bill
incident to that physician’s visit without the physician ever have to
actually see the patient. So this is just another exciting opportunity for
consultant pharmacists to get out there and see patients on their own, in a
clinic setting. If this video was helpful to you, be sure to subscribe and if you’d
like more information on pharmacist led clinical services join the Pharmapreneur Community Newsletter!

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