Primary Care Coding Alert

Policy: Use of CPT code 99211

Purpose: To clarify the use of 99211, thereby ensuring consistency of reporting and proper documentation to substantiate the charge.

Effective: Jan. 1, 2001

Definition: The 99211 code description per CPT is as follows: Office or other outpatient visit for the evaluation and management of an established patient that may or may not require the presence of a physician. Usually, the presenting problem(s) are minimal.

Overview: This code is generally considered a nurse visit as the code description indicates that the presence of a physician is not required. We can bill only one E&M code per patient per date. Therefore, this code is only used when we will not be charging for a physician visit for the patient on the same date. There are some instances where the AMA indicates the code may be used; however, this practice has a policy not to charge that service. For instance, it is the policy if this practice that we will not charge a nurse visit for BP checks, B12 injections, allergy injections or reading TB skin tests. Examples of when the code would and would not be used are specified below. When this code is used, patients will experience a co-pay (if applicable).

Appropriate Use of 99211

Chemo nurse spends extra time with a chemo patient teaching, discussing side effects, reviewing lab results, etc.

To report flushing a completely implanted vascular access device that does not have an implanted reservoir.

Dressing changes when the patient is not seen by a physician (examples: burn patients, central line dressing/cleaning).

Teaching patients to self-administer subcutaneous injections.

Required Documentation

A note on a shingle, 1 or 2 sentences describing what teaching was done, instructions given, results relayed, etc.

A written note in the medical record briefly describing the procedure (such as needle used, the amount of Heparin used to flush the device, etc).

A note on a shingle to describe what was done. Example: Dressing removed, condition of skin, application of Silvadene/Bacitracin, what dressing is applied.

A note on a shingle what is taught and results. Example: Patient watched movie. Procedure was reviewed, patient demonstrated skill. Written instructions given.

Sample policy provided by Sue Foster, business office manager for Buffalo Clinic, a 31-physician multi- specialty practice in Buffalo, Minn.