Pediatric Coding Alert

Hint: You can't automatically tack 99211 on to every service just because the nurse was present.Most pediatric practices agree that 99211 is a ubiquitous code, reported nearly every day for visits ranging from blood pressure checks to medication updates. But the so-called "nurse visit" code may not always be appropriate. Many payers are scrutinizing these claims and targeting them as "areas of concern." Check out these common clinical scenarios and determine whether 99211 is appropriate for the circumstances.Will 99211 Cover Vaccines?Question 1: A patient presents for vaccines only. The nurse administers two vaccines and the patient leaves. Should you report 99211 with the vaccine administration codes?Answer 1: Not as a rule, no. If the nurse simply administers a vaccine and the patient leaves, the nurse most likely has not met the medical necessity E/M criteria for billing 99211. If, however, the nurse spends a lot of time counseling the patient [...]