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Wiki 99211, not for providers???

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stephmhut

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Recently the billing office has hired some auditors who now are saying we can not use 99211 for providers?!?!?! Also that if there is not enough documentation for a 99212 then i can not bill anything at all. I have never heard anything so ludicrous!!!!!!!!

Any ideas? Advice?
 
You are correct... 99211 is a provider level. There is no nurse level, that is a label that coders have given to refer to the 99211, however it is not a nurse level. It is the providers level they may charge as a face to face for 5 min or less or they may charge when qualified ancillary personnel in the office are carring out the providers orders from a previous encounter while the provider is in the office. No matter how you say it it is a provider level ONLY.
 
Thanks! This lady is saying its ONLY for RN's/CNM's and of course incident to. But i was taken aback when she said that if there is not enough documentation for a 99212 then i could not code anything at all!!! So even if one of my docs saw a patient for a quick 5 minute visit then I could not code anything. Just sounds crazy. She also says she has documentation on this that I have requested to see. Would you know of documentation I could show her to counter this?
 
While I agree that 99211 must be billed under a provider since RNs do not have the ability to bill independently I don't see how a provider could see a patient and not qualify for at least a 99212.

All you need is a CC and 2 of the 3 components consisting of 1 HPI element, 1 element of exam, and SF MDM. If they don't have the documentation to support that I would question the medical necessity of the doctor being involved at all. If they are spending 5 minutes or less with the patient they still have to document enough to support billing an evaluation and management service whether they are a nurse or a physician/mid-level. I would be interested in seeing the documentation the auditor stated did not qualify for a 99212 or 99211 by the physician.

Laura, CPC, CPMA, CEMC
 
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