99211

[KristieStokesCPC]

When is it appropriate to bill 99211? Our system automatically generates a 99211 for every nurse visit; ie blood work, injections, immunizations... is it really appropriate to bill a 99211 for each nurse visit if they obtain vitals?

Thanks

 

[jsth10]

When is it appropriate to bill 99211? Our system automatically generates a 99211 for every nurse visit; ie blood work, injections, immunizations... is it really appropriate to bill a 99211 for each nurse visit if they obtain vitals?

Thanks

I have been told that any time a nurse spends five minutes with a patient they can charge a nurse eval. So if they give vitals, lab results, injections, or change medication they can charge a nurse eval.

 

[Lisa Bledsoe]

I don't believe this is correct coding. Nurse time/eval is usually included in the administration codes. You really should only use 99211 for a significant separately identifiable reason. Just because vitals are taken prior to the injection does not qualify for a nurse visit.

 

[jsth10]

I don't believe this is correct coding. Nurse time/eval is usually included in the administration codes. You really should only use 99211 for a significant separately identifiable reason. Just because vitals are taken prior to the injection does not qualify for a nurse visit.

According to the CPT 2008 manual a nurse eval (99211) can be billed for : office or other outpatient visit for the evaluation and managment of an established patient, that may not require the presence of a physician. Usually the presenting problems are minimal. Typically, 5 minutes are spent performing or supervising these services.

I know in my OBGYN's office if I have to come in for a minor problem such as needing to get a medication change or the nurse had to spend anytime with me they charge a nurse eval and they have a sign up in the front office letting you know that you may be charged a nurse eval for speaking with the nurse for certain reasons. So if a patients comes in for lab results that could have been given over the phone but they prefer to speak with a person face to face then they will be charged a nurse eval.

 

[dmaec]

I agree completely with Lisa on this
I think it's wrong to "automatically" bill out a 99211{that's my opinion on the posted matter}

I'd like to know what auditors think of this issue - how would you (auditors) view these charges? Would the explanation of "well, we automatically generate a 99211 charge when the patient comes in and sees a nurse", hold water for you? What kind of supporting documentation would you be looking for, as auditors?

 

[Lisa Bledsoe]

According to the CPT 2008 manual a nurse eval (99211) can be billed for : office or other outpatient visit for the evaluation and managment of an established patient, that may not require the presence of a physician. Usually the presenting problems are minimal. Typically, 5 minutes are spent performing or supervising these services.

I know in my OBGYN's office if I have to come in for a minor problem such as needing to get a medication change or the nurse had to spend anytime with me they charge a nurse eval and they have a sign up in the front office letting you know that you may be charged a nurse eval for speaking with the nurse for certain reasons. So if a patients comes in for lab results that could have been given over the phone but they prefer to speak with a person face to face then they will be charged a nurse eval.

The scenario above would be valid, but not if the patient came in for a shot. 99211 is an Evaluation AND Management code.

 

[Lisa Bledsoe]

Check out this link: http://www.trailblazerhealth.com/Publications/Job Aid/DocReqCPT99211JobAid.pdf

 

[wlacey]

Thank you for the article. I think the key word here is documentation. For just medication refills, blood pressure checks. .....If that is all that is written. It is not enough. My understanding is that this is the most abused code.
Wendy