99211

renifejn

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20 y/o w/ small PDA here with family to discuss catheter closure. No symptoms or other medical problems. Risks, benefits, and alternatives to procedure discussed. They asked appropriate questions and are interested in proceding w/ procedure.


Provider billed as 99211


What do you think?
 

valariej

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Most often 99211 is used for nursing care not physician services. does the documentation support billing 99212? I would suggest that if the physician saw the patient.
 
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CPT description for 99211 is ... "for the evaluation and managemet of an established patient, that MAY not require the presence of a physician." (emphasis added by FTB)

The word "may" allows us to bill this code when the established patient is seen only by the nurse. It does not preclude the physician from using this code.

The physician is correct - bill 99211.

F Tessa Bartels, CPC, CPC-E/M
 
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One more thing ...

You might want to counsel the physician about using time to bill for counseling/coordination of care. If s/he had added amount of face-to-face time spent with patient and family, and a notation that over 50% of the time was for counseling/coordination of care, you could bill the E/M based on total time spent:

99212 - 10 minutes
99213 - 15 minutes
99214 - 25 minutes
99215 - 40 minutes

F Tessa Bartels, CPC, CPC-E/M
 

ARCPC9491

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yup, I agree w/ Tessa - though the documentation he provided is very minimal and justifies 99211 - he/she could have bumped it up a notch if they properly documented the time component~!:D

If you use templated forms, I'd add that line in there ..... "more than 50% of this encounter was spent face-to-face w/ patient counseling/coordinating care. Total time: _____mins"

That way they are always 'reminded' <well we hope!> to put 2 little numbers in the blank...;)
 
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