Wiki 99211-dietician

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rross

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I work in an hospital outpatient department, one of the nurses asked if a dietician visit would be classified as a 99211 when called in on the same day the patient is receiving treatment. I am thinking it would be, however I know she spends more than 5 minutes with them. I would appreciate any guidance.
 
If you are billing for the facility then a visit in each department may be billed so you may have multiple visit levels just use the 27 modifier on the second and subsequent and a G0 condition code. As far as can this be a 99211 that depends on how your E&M assessments are evaluated. It can be whatever level your facility values it to be, a 99211, 99212, etc. there needs to be some way to assess this type of encounter in your facility.
 
the dietician discusses their eating habits/ability.. if she finds pt is unable to eat, she will provide them nutritional supplements such as ensure.
 
In the facility I worked with we had any social work or dietician discussion rated as simple, 99211, moderate, 99212, and extensive was 99213. We then had our criteria for what was involved with each level, remeber time is not a factor in the facility. It is what resources were consumed. For the typw of discussion you are talking about it could go up to a 99212. You just have to remember that facility billing is very different from physician and the criteria for E&M is not even remotely similar.
 
Okay, in order to be in compliance...do you have any recommendations on what would be the best way to make sure there is documentation to cover her visit with the patient. Currently the nurses are only documenting that they had her come. The dietician doesn't document in our paper charts. Should we have her start doing so?
 
That would make sense..however, shouldn't the dietician be charging that? Our nurses don't provide the service, they just call her in. Our nurses evaluate the patient's needs, then if needed or requested they call in the dietician, social worker, and/or the counselor. None of which enter charges, so they are basically free services. Not real sure if that is the way it is suppose to be. So, should we be charging for these?
 
rross said:
Okay, in order to be in compliance...do you have any recommendations on what would be the best way to make sure there is documentation to cover her visit with the patient. Currently the nurses are only documenting that they had her come. The dietician doesn't document in our paper charts. Should we have her start doing so?
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Yes absolutely! And your outpatient assessment tool or whatever you call it should have a way of assessing the documentation for a visit level.
 
I suppose you could use the 97802 codes but you should check to see the revenue center relationship with those codes, they may not work in in a 510 revenue center. My recollection is that they did not which is why we used a visit level when performed in our 510 clinic setting.
 
My experience is that a nutritionist billing 99xxx anything is really unable to document a visit at that level. The 97802 and 97803 is more appropriate. Coding E/M increases the payment by about 2X, by the way.
I'm not sure how this figures if the service is provided IP.
 
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