Oncology & Hematology Coding Alert

Experts answer 3 common questions for this troublesome E/M code

CPT offers code 99211 for evaluation and management of minimal problems, but the confusion over using this code has been far from minimal.

Get on the right track with this expert advice on the often-misused 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services). Consider 99211 to Be More Than Nurse's Code Question: Which members of a practice's medical staff can report 99211?
 
Answer: Many coders don't realize that they can bill 99211 to report services that clinical staff other than the nurse provides, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver.

Don't overlook: 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. These clinicians can report 99211 as long as the patient visit meets the medical-necessity requirement for billing an E/M code.

Although CPT does not bar physicians from using 99211, oncologists normally use higher-level E/M codes because of the greater complexity of care they provide. If your physicians- documentation frequently supports reporting 99211, they may need to work on improving their documentation, Hammer says. -This may not be a very efficient use of their time.-

If an auxiliary personnel member performs an E/M service and plans to report 99211, the physician must be present in the office space, and the auxiliary personnel must be qualified to perform the service based on state scope of practice. Because your practice reports 99211 as an incident-to service, the provider would have to be monitoring a problem that the physician already evaluated, because you cannot bill incident-to if the nonphysician practitioner evaluates a new problem.

Medicare interpretation: The physician's presence is not required at each 99211 service involving a Medicare patient, but the physician must at least be in the office suite when each service is provided. The physician must also initiate the service as part of a continuing plan of care. He should be an -ongoing participant- in this care, which to some carriers means he must see the patient at least every third visit.

Watch for: New code 90772 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) includes an instruction that you shouldn't report 90772 for injections given without direct physician supervision. The instruction tells you to report 99211 instead. Problem: You need
direct supervision to report 99211, as well. We-ll keep you apprised of any [...]