Otolaryngology Coding Alert

By reviewing who performed the service, the service performed and the associated diagnoses, you can ensure that your otolaryngology practice receives proper payment when you report 99211 (Established patient office visit usually the presenting problems are minimal). Remember that 99211 usually triggers a copayment, and your practice should inform patients of this. In addition, the code is for established patients. 1. Did Auxiliary Personnel Perform the Service? "99211 is often called a nurse visit," says Catherine Brink, CMM, CPC, president of Health Care Resource Management Inc. in Spring Lake, N.J. It is the lowest-level E/M visit for an established patient and is typically used when the nurse sees a patient for a minor problem. Although Medicare does not bar physicians and nonphysician practitioners, such as nurse practitioners and physician assistants, 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.

Many coders don't realize that they can use 99211 to report services by office 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, can provide services to patients incident-to the physician using 99211. To bill incident-to:

the staff must perform the service under the physician's direct supervision the visit must meet the medical-necessity requirement for billing an E/M code. Direct supervision means the physician must be present in the office when the auxiliary personnel perform the service. In addition, the staff person must be qualified to perform the service. Note: For more on auxiliary personnel, read Section 2050.1 of the Medicare Carriers Manual. 2. Does a Code Describe the Service? Coders frequently question whether they can use 99211 when a patient comes to the office for common procedures, such as allergy shots. The first question the coder should ask is: Does the service that was provided have its own CPT code?

"If the service has an identifiable code, bill that code, and not 99211," Pride says. Routine Hearing Checks Aren't Covered For example, an established patient comes in complaining of dizziness (780.4) and sees the audiologist. She performs audiometric testing, including comprehensive audiometry threshold, impedance and acoustic reflex testing. In this case, report the CPT code for each test: 92557(Comprehensive audiometry threshold evaluation and speech recognition [92553 and 92556 combined]), 92567 (Tympanometry [impedance testing]) and 92568 (Acoustic reflex testing). You cannot code 99211 for the time that the audiologist spends with the patient unless she provides another medically necessary service in addition to the hearing tests. For instance, the audiologist performs a "dizzy-patient workup" in [...]