School-Based Health Services Nursing Billing Form Guidelines
Guidelines effective August 1, 2019, for school-based health services nursing billing, including consent for Medicaid billing, documentation requirements, and instructions for physician authorization. Details on student demographics and service record documentation are also provided.
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Cha p ter 2 38 Sc ho o l - Ba sed Hea l th Servi c es Nursing Services Billing Form Effective August 1, 2019
Co nsent to Bi l l M edi c a i d Prior to billing parents must provide written consent to release information and to bill for Medicaid reimbursement. Consent is valid for one calendar year from the signature date. Parents are to be provided an annual notice. 2
P l a n o f Ca re Services must be documented on the Plan of Care signed by the parent and therapist. Effective August 1, 2019 Service Care Plan is now called a Plan of Care. This provides more consistency and avoids a terminology conflict with private school service plans. There is not a need to have a new one signed if it says Service Care Plan The IEP Program has been adjusted to reflect the change in terminology. Specific ICD-10 diagnosis codes are required. ICD-10 codes must relate to the specific type of therapy being provided. Think of these more as treatment diagnosis codes. All appropriate diagnosis codes need to be listed on the Plan of Care. A global code such as Autism would not be appropriate. A copy of the nursing health care plan is to be included with the Plan of Care. 3
P hysi c i a n Autho ri za ti o n F o rm Nursing services are not included on the Physician Authorization Form as doctor orders are provided in conjunction with nursing services. 4
Student Dem o gra p hi c s Use the student s real name as listed in WVEIS The diagnosis code is to be an ICD-10 code that matches the need for nursing services. County and school names can be written out or use the county and school WVEIS codes. For provider name print the name of the person providing the service. 5
Servi c e Rec o rd Servi c e Rec o rd Sc ho o l Based Nursi ng Servi c es Sc ho o l Based Nursi ng Servi c es Bi l l i ng F o rm Bi l l i ng F o rm Medicaid Number Last Name First Name WVEIS Number Date of Birth Provider Name County School Month/Year 6
Servi c e Rec o rd Servi c e Rec o rd Sc ho o l Based Nursi ng Servi c es Sc ho o l Based Nursi ng Servi c es Bi l l i ng F o rm Bi l l i ng F o rm Medicaid Number Last Name First Name 03900000005 Doe Shamus WVEIS Number Date of Birth Provider Name Mary Smith 999999999 1-3-2008 County School Month/Year 59 501 Sept/2019 7
Di a gno si s Co des Enter the specific ICD 10 Diagnosis Codes related to nursing services on the form starting with box number one. Enter the codes that are directly associated with the services/or assessments. 8
I CD 10 Di a gno si s Co des LIST ALL DIAGNOSIS CODES RELATED TO NURSING SERVICES 1. 2. 3. 4. 5. 6. 9
I CD 10 Di a gno si s Co des LIST ALL DIAGNOSIS CODES RELATED TO NURSING SERVICES 1. E10.9 2. T78.01XA 3. F90.1 4. J45.901 5. 6. 10
Nursi ng Servi c e P ro c edure Co des Authorized Individual Nursing Services/Treatments: *Anaphylactic Reaction Assessment/Evaluation (T1001 SE) (2 Events/Calendar Year) * If providing services via Telehealth use an additional modifier of GT. Seizure Management (T1001 SE) (2 Events/Calendar Year) *Diabetic Management (T1001 SE) (2 Events/Calendar Year) Manual Resuscitator (92950) (10/Calendar Year) 11
Nursi ng Servi c e P ro c edure Co des The following procedures use T1000 SE code: Each of the following procedures can be billed, with a maximum of 10 units for each procedure per instructional day, (1 Unit = 15 minutes) Long Term Medication Administration Emergency Medication Administration Mechanical Ventilator *Inhalation Therapy Catheterization *Catheterization Self- Management *Measurement of Blood Sugar Postural Drainage and Percussion *Subcutaneous Insulin Infusion-by Pump *Subcutaneous Insulin Infusion by Injection Tracheostomy Care *Peak Flow Meter Ostomy Care Oxygen Administration Oral Suctioning Enteral Feeding (tube feeding) Anaphylactic Reaction Individual * If providing services via Telehealth use an additional modifier of GT. 12
Nursi ng Servi c e Cha nges *Diabetic Management T1001 SE (2 Events/Calendar Year) *Catheterization Self-Management T1000 SE (Units) 13
Nursi ng Tel ehea l th Telehealth is now available for some procedures within T1000 SE: Inhalation Therapy Available for self-administration only with RN or LPN at main site Catheterization Self-Management Measurement of Blood Sugar Available for self-administration Subcutaneous Insulin Infusion by Pump Available for self-administration Subcutaneous Insulin Infusion by Injection Available for self- administration Peak Flow Meter Available only with RN or LPN at main site. If using Telehealth an additional modifier is required of GT. So the CPT code would be T1000 SE GT. It is very important to enter the modifiers in that order. 14
Nursi ng Tel ehea l th Telehealth is now available for two procedures within T1001 SE: Anaphylactic Reaction Assessment/Evaluation Available for self- administration only with RN or LPN at originating site Diabetic Management Available for nurse supervision for self- administration If using Telehealth an additional modifier is required of GT. So the CPT code would be T1001 SE GT. It is very important to enter the modifiers in that order. 15
E nter Cl a i m Do c um enta ti o n Use the CPT codes and caps from slide eleven to complete the claim documentation section of the billing form. In the first column list the service date. (If combining minutes from different days for a unit use the date the 15th minute occurred to complete the unit. No span dates are allowed.) Column two - enter one or more of the diagnosis code numbers that directly relates to the services. (examples 1, 1 & 3, 2) Column three - enter the CPT code including a GT modifier if being provided by telehealth. It is very important to enter the modifiers in the correct order. The SE modifier must come first. Example - T1000 SE GT. Columns four and five - enter the start and end time. In the last column enter the total number of units or event(s). 16
Cl a i m Do c um enta ti o n Service Date List Diagnosis Code Number(s) Procedure code Start Time End Time Units/Event 17
Cl a i m Do c um enta ti o n Service Date List Diagnosis Code Number(s) Procedure code Start Time End Time Units/Event 18
Thi rd P a rty Bi l l i ng At times a student may be eligible for Medicaid as the secondary insurance. Medicaid is the payer of last resort for direct services (OT, PT, Speech, Audiology, Psychological, and Nursing). If the student has special transportation services, the direct billing should be submitted. The claim will be denied but will justify claiming transportation billing for that instructional day. Medicaid will pay ancillary services (TCM, personal care aide and special transportation) as the secondary insurance. Occasionally a student may be eligible for Medicaid under two numbers. In this case district s should always use the primary Medicaid number. 19
Si gna ture a nd Credenti a l s _____________________ Signature/Credentials Date ______________ 20
Si gna ture a nd Credenti a l s ___ RN___ October 1, 2019 __Mary Smith Signature/Credentials Date 21
Addi ti o na l Do c um enta ti o n A copy of the student s nursing notes for the month will also be required. A copy must be on file in the special education central office.
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