Otolaryngology Coding Alert

And be sure you avoid this one common pitfall at all costs

Although you might be tempted to -write off- a 99211 charge when billed on the same day as an immunization administration, don't give in. You can get reimbursed for both codes as long as the encounter involved a significant, separate problem unrelated to the procedure.

Knowing when you-re able to code for both the E/M and the procedure is a trick issue that stumps many coders. -If we make an appointment, pull and prepare the chart, obtain a history, and prepare and administer the vaccine with chart documentation, should we bill for 99211?- asks Debbie Argo, office manager at Family Care of Kent in Kent, Wash.
 
Look for this information when determining whether you should bill 99211 with 90465-90474. CC, Problem Justify Separate E/M You should report a medically necessary E/M that is significant and separate from the immunization encounter. -When the provider (usually the nurse) evaluates, manages and documents a complaint(s) or problem(s), you can justify the additional reporting of CPT 99211,- says Steven M. Verno, CMBSI, CMMC, CMMB, NREMTP, compliance director with the Medical Association of Billers.
 
To identify a stand-alone 99211, you can check for these bullets. The nurse typically:

- conducts a brief history

- performs a chart review along with a physical assessment (such as indicated vital signs and observations)

- provides patient education in helping the family or patient manage the problem encountered. Key: -These nursing activities are all directly related to the significant, separate complaint and are unrelated to the actual vaccine administration,- Verno says. Different Diagnoses Solidify Billable Service Looking at the diagnoses can help you spot a service that warrants coding a nurse visit. -Additional diagnoses on the encounter sheet should alert you to report 99211 with modifier 25,- says Maria M. Torres, CPC, CMM, CCC, CMSCS, a primary-care consultant with Bermudez Medical Consulting Services in Tampa, Fla.

Why: Using different diagnoses helps show the payer that the nurse's service is medically necessary and separate from the vaccine administration. CPT, however, does not require you to report a separate ICD-9 code for the visit and the immunization administration. E/M, Procedure Notes Demonstrate 99211 If you can draw a line between the E/M service and the vaccine administration, you can safely bill 99211. A separate nurse visit should include the following documentation:

- the date of service

- the reason for the visit (chief complaint or CC)

- a brief history of any significant problems the nurse evaluates or manages

- any examination elements (such as vital signs or appearance of a rash)

- a brief assessment and/or plan along with any counseling or patient education

- signatures of the nurse and supervising physician.

The nurse should record the above items in a separate entry from the vaccine documentation. The provider [...]