99211 with 93284


West Point, CA
Best answers
Verifying the appropriateness of billing a 99211 with 93284; Patient is seen by MA, no BP done, brief HPI and statement that 93284 was performed. No other details. No report for the 93284 and no signature by MD.
I realize the 99211 would require a mod 25, but is this an appropriate usage of 99211? It seems the 93284 requires the presence of the MD. There are no CCI edits for this code pair. Please advise. Thanks.
You cannot use a 99211 for a service/procedure that was previously scheduled. Since an MA is not the one that determined this service was to be performed, it was most likely scheduled from a previous encounter. Also the 83284 description indicates that this must include a review and report by the physician or qualified health professional. Unless your MA is included in this category then they would not be the one performing this service. Also the provider would need to be in the office at the time of the service to billable at all. From what you have indicated, there is no billable service for this encounter.
99211 would require documentation of an identifiable E&M service that was ordered by the provider in the plan of care and performed by the MA. If all the MA did was check the patient in for the defibrillator evaluation, then there certainly is nothing to support billing 99211, with or without a modifier. 93284 does not require presence of the MD in the room with the patient, but does require a physician interpretation and report for the professional component (or global billing). The technical component can be performed by staff, but it does require direct supervision by the physician, so the physician would have to at least have been present in the office to bill that component.