Orthopedic Coding Alert

If you-re using it only for nurse visits, you could be losing out You may think of 99211 as the -nurse's code,- but you could be using it for other situations. And if you can report it, you should, experts say.

Code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) differs from the other office visit codes in that it does not require the three E/M components. In addition, the code descriptor specifies that the visit -may not require the presence of a physician.- Use these criteria whenever you report this code. Actual E/M Service Is a Must-Have Most medical practices report 99211 for brief but medically necessary visits with a nurse or other applicable nonphysician practitioners (NPPs), such as physician assistants (PAs), nurse practitioners (NPs) and certified nurse specialists (CNSs). The NPP must perform the E/M service, however, so you don't use 99211 simply to get a service paid.

Example: A nurse speaks to a patient on the phone and agrees to obtain a prescription refill for her. The patient comes to the practice an hour later, and the nurse hands her the prescription through the reception window.

Coding solution: Because the nurse did not evaluate the patient and no medical necessity required her to meet with the patient, you should not report an office visit for this service, according to Suzan Hvizdash, BS, CPC, CPC-EMS, CPC-EDS, physician educator for UPMC, University of Pittsburgh Physicians- department of surgery. On the other hand, if the nurse couldn't renew the patient's prescription without evaluating her, she should have documented the medical necessity to support reporting 99211.

Look for key phrases: Anytime you report 99211, the NPP should document the reason for the visit, a brief history of the patient's illness, any exam elements such as weight or temperature, and a brief assessment. Check the documentation for notes like, -Wound has healed well- or -Swelling has decreased,- to serve as proof that the practitioner met with the patient, says Linda Martien, CPC, CPC-EDS, CPC-H, coding consultant with National Healthcare Review in Woodland Hills, Calif.

If a qualified mid-level provider performed the encounter, your code choices would include other E/M services as well (for example, 99212-99215), Hvizdash says.

In addition, make sure you have the date of service, the reason for the visit, proof that the NPP performed the service according to the orthopedist's orders, and the NPP's signature on the note. Although the history, exam and medical decision-making components are not directly part of this E/M service, there must be documentation, and it should still accurately and thoroughly paint a picture of the visit, Hvizdash adds.

Keep in mind: You can report [...]