Pediatric Coding Alert

Reader Question:

Document 'Nurse Visits' to Justify E/M Code

Question: A 6-year-old patient with a history of strep throat reported to the office with complaints of a sore throat but no fever. The nurse checked the patient's temperature, weight and history and collected a throat culture. The pediatrician wasn't present during this visit. How should I report the visit?

Minnesota Subscriber Answer: Report 87880 (Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A) for the strep test and 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician) because the nurse also performed a level-one E/M service. Be sure to document the weight, height and history checks the nurse performed. Otherwise, it will be difficult to prove she provided a 99211-level E/M service.

- Information for Reader Question and You Be the Expert provided by Richard H. Tuck, MD, FAAP, medical director of Quality Care Partners in Zanesville, Ohio.
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