Wiki Billing 99211 and 85610

[lori85210]

I'm at an Internal Med clinic and wanted to know if billing 99211 and 85610 (INR) is correct. Basically the pt is scheduled for INR check per doc and the MAs do the finger stick for INR. The patient never sees the doctor that day, BP and Vitals are always done before their INR. So can 99211 be billed when MAs are doing all this under the care of a physician?

Confused in Arizona....

 

[mitchellde]

no you cannot use a 99211 when a CPT code exists for the service rendered. For a fingerstick you use the 36416 and that will encompass all of the work performed by the MA.

 

[burksmail]

You can bill 99211 as long as the complete documentation is there and the pt is an established pt returning for a physician ordered service. I was in a class where the following criteria were given for the nursing/MA documentation that would qualify for billing 99211: 1) the order from the physician 2) the reason for the service (dx) 3) nursing assessment as inidcated 4) nursing action as indicated 5) patient instructions 6) follow-up 7) nurse's legible signature (not initials) and credentials. Further, the supervising physician must be in the office at the time of the encounter.

Remember, the description of 99211 includes "evaluation and management" so this must be shown in the documentation. The evaluation portion is substantiated when the record includes documentation of a clinically relevant and necessary exchange of information between provider and patient. The management portion is substantiated when the record demonstrates an influence on patient care (eg, medical decision making, patient education, etc.).

You would want to check payor specifics as well.

I want to add that I'm not sure I agree with billing 99211 when a patient comes back in for a blood draw or other service required by the physician as it seems an excessive expense for the patient. However, I do also understand that if medically necessary and the documentations supports it, it can be billed.

Myra, CPC, CPC-H

 

[Willingham]

99211 and 85610

If I understand you correctly the pt. is just coming in to have his INR checked. You can not use 99211 for MA if it were a Nurse yes. I guess you could code the 36416 but MA's don't have any type of PIN no. so I guess you would be submitting this code under the provider's name assuming he has written the order for the INR to be checked.

 

[mitchellde]

I disagree, there is no reason to charge the 99211, a code exists for the fingerstick and you cannot chose alternate codes based on payment. Medicare is the gold standard in this business and they have stated numerous times that a 99211 cannot be used for blood collection or injection admin encounters. There is no need for an assessment beyond vitals which are an inclusive part of the procedure. The assessment of the patient to determine the need for the INR has already been performed at a previous encounter and cannot be charged again.

 

[lori85210]

Thank you for all the quick replies. All your answers were helpful.

Not too confused anymore in Arizona