Part B Insider (Multispecialty) Coding Alert

Published on Tue Jul 26, 2011 PDF

Even if you aced our 99211 quiz on page 234, it's a good idea to brush up on some basic facts about using 99211. Keep the following in mind when you report this level one office visit code:

It's not just for nurses. Although it's commonly referred to as the "nurse visit code," in actuality, physicians, nurse practitioners, and physician assistants can use 99211 as well as nurses.

The patient must be established for the nurse to bill 99211. If a non-physician bills under the billing physician's name using 99211, you still have to make sure you follow the "incident-to" regulations, which means that it only applies to established patients, and the physician must be on-site at the time of the visit. In addition, "the documentation should also demonstrate the 'link' between the non-physician service and the precedent physician service to which the nonphysician service is incidental," according to Documentation Requirements for CPT® Code 99211, published by Part B MAC Trailblazer Health Enterprises.

Chemotherapy services and 99211 don't go hand-in-hand. If a patient presents for a chemotherapy infusion, you should report thechemotherapy administration code (such as 96401 or 96402 for non-hormonal anti-neoplastic or hormonal anti-neoplastic) alone, without adding 99211. "The carrier shall not allow CPT® code 99211, with or without modifier 25, to be billed or paid on the same day as a chemotherapy administration service or a nonchemotherapy drug infusion service," CMS says in Transmittal 147.

Blood pressure checks only qualify for 99211 if you document these 5 items: If a patient comes in for a blood pressure check, you can't automatically report 99211. You must first document that blood pressure and other vital signs were reported, the clinical reason for checking the blood pressure, a list of current medications, an indication of the doctor's evaluation of the clinical information and his management recommendation, and the identity and credentials of the provider, according to TrailBlazer's Documentation Requirements for CPT® Code 99211.