General Surgery Coding Alert

How much do you really know about when to report code 99211? Take the following short quiz, and then look at the box below to check your answers against those provided by coding experts. 1. Which members of a practice's medical staff can report 99211?
2. Should you use 99211 if the service provided has its own CPT code?
3. Can you report 99211 if the physician phones in orders or a care-plan change?
4. Can practices report 99211 for prescription refills?
5. When a patient comes in for an injection, can you bill 99211?








1. Many coders don't realize that they can use 99211 to report services provided by specified clinical employees other than the nurse, says Kathy Pride, CPC, CCS-P, HIM applications specialist with the San Rafael, Calif.-based QuadraMed.

Any qualified "auxiliary personnel" who are employees of the physician (such as medical assistants, licensed practical nurses, technicians and other aides) and are working under the physician's direct supervision can provide services to patients under the incident-to umbrella using 99211, Pride says. These clinicians can report 99211 as long as the patient visit meets the medical-necessity requirement for billing an E/M code, she says. The physician must be present in the office space, and the auxiliary personnel must be qualified to perform the service. (For more information on auxiliary personnel, read Section 2050.1 of the Medicare Carriers Manual.)

Although CPT does not bar physicians from using 99211, they will use a higher-level E/M code in most cases because of the greater complexity of care they usually provide. 2. "If the service has an identifiable code, then you bill that code," Pride says. For example, a patient comes to the office for a urinalysis as part of routine lab work scheduled a week before a regular checkup. In this case, you should use 81002 (Urinalysis, by dipstick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy) instead of 99211.

You cannot code 99211 for the time that the nurse or assistant spends with the patient unless another medically necessary service is provided in addition to the lab work, such as if the routine urinalysis is positive, indicating a urinary tract infection.

In this case, the nurse must then discuss the findings with the surgeon, who decides he doesn't need to see the patient before the exam the following week but will write a prescription for an antibiotic to be started in the interim. The criteria for medical necessity have been met, and 99211 can be coded in addition to 81002, with diagnosis code 599.0 (Urinary tract infection, site not specified). On the other hand, if the service provided to the patient by [...]