Wiki Billing 99211 w/protime

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Our office does charge the 99211- because it requires a Physician to review the results-he reviews before the patient leaves the office.
 
I've always billed 99211 when some E/M is involved beyond the venipuncture itself. The clinician doesn't do any exam but he/she does review the PT/PTT results and monitor the treatement plan.

If an exam is performed by the physician (the excessive bruising scenario in the link---thanks Lisa) the visit probably qualifies for a higher level visit.
 
Lisa Curtis said:
Yes you can. Check this link (specifically page 3):
http://www.trailblazerhealth.com/Publications/Job Aid/DocReqCPT99211JobAid.pdf
Click to expand...

I think this should be very carefully done. I still say no to a 99211 for a nurse blood draw and this publication says the same thing If you look it states when NOT to use a 99211 and the fourth bullet says:
• When drawing blood for laboratory analysis or when performing other diagnostic tests, whether or not a claim for the venipuncture or other diagnostic study test is submitted separately

On page three it is talking about using the 99211 as a physician encounter for:
Therefore, the documentation for code 99211 or any other E/M code in this circumstance must demonstrate a need for clinical evaluation and management. In this case, services that would serve to demonstrate that evaluation and management was performed include an evaluation of significant new symptoms (such as excessive bruising or hemorrhage). Alternatively, for patients who have no new clinical concerns, documentation that contemporaneous laboratory values were obtained, reviewed, and used to guide current and/or future therapy documents that a separately payable E/M service has been performed.
When a pt comes in for a routine PT and the nurse is the only one involved face to face I feel this supports that this is NOT a valid encounter for a 99211. JMO
 
If a patient comes in for a routine protime for which they see the nurse who does the appropriate evaluation and documentation, pricks the finger, documents results, discusses with MD any change in dosage, again documents appropriately; in my opinion this qualifies for 99211.
 
I have submitted this question to Trailblazers (my carrier) and included their link/rationale as well as the one Laura just posted from WPS. I am extremely curious and anxious to hear from them. I'll post the answer when I receive it.
 
My office does not charge a 99211 nurse visit for a pro-time, there is no above and beyond in that especially if all thats being done is documenting the INR and giving the patient their dosage. What significant e/m is being done here, whats above and beyond - is there some type of problem being encountered here? I'm sure there can be complications/problem encountered and I would agree then and only then to charge a 99211 with proper documentation--- but if there is no significant change... I would not charge 99211.

Just my opinion
 
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