Q: We are re-considering a treatment room charge but wanted to reflect on what we currently make on the treatment room/wounds etc. Is there an item number they use for wounds, or is it all ‘free’ nursing time?
A: Implementing any treatment room fee that would make the exercise profitable is challenging. Most practices charge a $20 treatment room fee on top of item 23. However, this is complicated because Medicare does not allow bulk billing of item 23 and charging a $20 treatment room fee simultaneously. To comply with the rules, the practice must produce two invoices: a private charge for item 23 invoiced under the doctor and a $20 treatment room fee invoiced by the clinic. More advanced clinics might use items 10997, 721, 723, 732, and 701 (AUSDRISK assessment) to improve the average billing for treatment room attendances, such as combining several items like 23/23/23, 10997/23+701/721.
Q: With item 10997, what situations can this be billed in? Or is it only when the nurse is completing a care plan/review?
A: Item 10997 can be billed when a nurse addresses any issue mentioned in the Care Plan. Let’s break this down:
a. The patient must have an existing Care Plan.
b. The nurse’s actions must align with what is outlined in the Care Plan.
What can be mentioned in the Care Plan? It can include a wide range of clinical and social information, such as weight measurement, blood pressure monitoring, diabetic complications management (e.g., diabetic ulcers), health education, queries about attendance by allied health practitioners, medication adherence, and lifestyle-related discussions.
These interventions do not need to be lengthy; the duration—whether a minute or twenty—is not crucial as long as the interaction is meaningful. Item 10997 should not be billed concurrently with creating the Care Plan. 10997 Can be billed with Care Plan Review. Otherwise, it can be billed alongside any other item or as a standalone item. Importantly, the doctor does not need to see the patient or be present at the practice for item 10997 to be billed.
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