Wiki billing for a 99211 with 80307 in a pain clinic

[PBarnes149]

Hi, I posted this in a different forum, and although there many views, there were no responses. This may be a very basic question for some, but I need some advice. Thank you all.

Hoping for clarification. We have patients enrolled in a pain management program that come in once a month. Sometimes the patient comes in and the MA takes vitals, asks the patient how the pain is, are there any problems with the current medication, takes the patient to rest room so the patient can give the urine sample, collects the sample and forwards to our in house lab . The patient does not see the physician. Can we bill a 99211 and the 80307? I am new to this and want to make sure we are billing correctly. Thank you in advance.

 

[Carol Hudgens]

If you are not performing the urine test in the clinic you can not charge for collecting the specimen.

 

[PBarnes149]

We do the urine test in house. We are a certified CLIA lab. Thank you

 

[thomas7331]

In order to bill a 99211, all of the 'incident to' requirements must be met, including that the MA must be performing a service that is ordered by the physician and part of the plan of care, and the supervising physician must be present in the office. In addition, the E&M service would need to be something that is medically necessary and separately identifiable from the routine work of collecting the lab specimen.

The NGS Medicare MAC has a really good job aid that details exactly what they look for in documentation to support a 99211 - you can find that on their web site here: https://www.ngsmedicare.com/ngs/por.../?clearcookie=&savecookie=&REGION=&LOB=Part B

 

[amelia77]

I work in a pain clinic, and we do not bill for an office visit if the patient hasn't been seen. If they are only doing the uds then we only bill the 80307.

 

[PBarnes149]

Thank you for your responses. I appreciate the insight.