99211 - I am hearing that the AMA

rleone

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I am hearing that the AMA uses an example of a patient presenting to the window, saying they lost their prescription, the prescrition being rewritten and the billing being 99211. I thought that the E&M would entail a patient being evaluated by an actual visit, not a chart evaluation. I know that it does not require a Provider and a nurse can charge a 99211 but I really always felt that the patient did need to actually be engaged in some way other that on paper. Would appreciate some input. thanks
 

JoyJoy

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I work in a multi-specialty group and do the coding for the Internal Medicine/PCP's and also Pediatric groups. The patient does need to be engaged in some way physically, ie. the administration of a vaccine, receiving a bandage. Speaking to the patient over the counter, looking in the patient's file and reissuing a prescription is not billable. That would be the same as the patient calling in for the prescription and that is also not billable. 2 thumbs down on that one.
 

rleone

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99211

Thanks for validating my interpetation. I looked in the clinical examples in the CPT book which I think this person who sent this info was reffering to. They don't say "presents to window" as this gentleman quoted but neither are they clear about what type of involvement is necessary.
 

MSJM

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99211

I have a friend who codes for a physician's office and they do not charge for visits when a patient comes in for a pacemaker check by the nurse. Can't they bill 99211 in that situation?
 
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What's the definition of engaging?

If you look at the definition of 99211, there are no key element requirements, and it "may not require the presence of a physician." Our guideline is that all you need is a chief complaint.

The CPT clinical examples for 99211 includes one of a person coming in to replace a lost prescription (pg 476 of 2008 CPT professional edition). No, it doesn't state "to the window." But if the nurse comes out to the counter, writes out the script and hands it over, it's definitely face-to-face. And,in my book that's "engaging" the patient. Is it HIPPA compliant ... I don't think so ... but that's not the question.

And to Melanie ... yes, I would think a nurse checking the pacemaker might qualify for 99211.

That's my interpretation and opinion,
F Tessa Bartels, CPC, CPC-E/M
 

heatherd781

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I am doing some research for the office I work for and I found on one of the Medicare sites that in order to bill 99211 you have to spend at least 5 minutes witht the patient.
 
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