Wiki Can you bill a 99211 with a UA?

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Orthocoderpgu

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Patient comes in for a UA only due to UTI. Never sees the doc. I know we can bill the 81002 for the UA but can we bill the 99211 or just the UA? Thanks for your help.
 
It depends.

I would say that depends on whether or not you have documentation that the patient saw a nurse or MA.

99211 is MD-not-required lasting less than 5 minutes so there doesn't have to be a lot to the documentation, but there has to be proof of a face-to-face with someone.

To clarify, yes, I agree it has to be other than performing the dip/reagent. That's what I meant by "saw" the nurse or MA. Presumably, the nurse would document the patient's current complaint and discuss the case with the MD and they would develop a treatment plan or not if it isn't warranted. Then the 99211 is perfectly legitimate.
 
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Does the documentation support a separate service above and beyond the work already performed and captured as 81002.

If so, then code 99211-25. If not, code 81002 only
 
I agree with cheermom, but unless the patient self-diagnosed, she/he is probably coming in due to a symptom ie urinary pain. The DX of UTI would have to be established by the Doc

I was reading the question as "come in for a urine test. If it shows clear, then you will see the Doc to DX the problem. If it shows abnormal, then you will see the Doc for DX and treatment". Which is why I suggested the presenting problem was a symptom and not a DX
 
Modifier-25

Suppose if received documentation supports with both these codes in this senario, then its appropriate to append modifier-25 with 99211 CPT code?

sbicknell said:
Does the documentation support a separate service above and beyond the work already performed and captured as 81002.

If so, then code 99211-25. If not, code 81002 only
Click to expand...
 
If the patient comes into the office expressing symptoms and the nurse does the ua, but the physician does not see the patient then a 99211 may not be billed at all. You may bill for the UA. This cannot be a 99211 from a nurse or physician standpoint. The physician has not evaluated the patient to establish a plan of care for this dx so therefore it cannot be incident to and the physician does not see the patient face to face so it is not a physician encounter.
 
Some resources and their position on the UA example

An established patient comes to the office with complaints of urinary burning and frequency. The nurse takes a focused history, reviews the medical record, discusses the situation with the physician and orders a urinalysis. The nurse then presents the findings to the physician, who writes a prescription for an antibiotic. The nurse communicates the instructions to the patient and documents the encounter in the medical record. In this example, 99211 and the appropriate laboratory code for the urinalysis should be reported because the E/M service is distinct from the lab service and appropriate for the evaluation of the patient's complaint.

http://www.medscape.com/viewarticle/481337_2
http://www.aafp.org/fpm/2004/0600/p32.html
http://www.supercoder.com/articles/articles-alerts/pca/three-questions-resolve-99211-conundrum/
 
I disagree the physician must see the patient face to face before a physician level can be charged. The nurse cannot render the dx to the patient. A decision health articel from 2002 Feb 11 which was written by Kathleen Mueller the compliance officer for CMS discussed this exact scenario. There is no plan of care for the nurse to be following so it does not meet incident to criteria. It is not a shared encounter as the physician does not see the patient face to face and write his assessment. There is no basis for a physician visit level, and a 99211 is a physician visit level there are no visit levels for nurses.
 
Judgment Call...

I'd say this is one of those "hot" topics and a judgment call on the part of the physician and the coder. Payers may handle it differently and if this isn't a Medicare patient, I'd take it in to consideration.

There are certainly sources to cite to support you in billing it (including the AAFP) and I don't think anyone is going to suffer any major consequences for a $10-ish nurse visit billed in good faith. Even if more than once.
 
Here is something to think about. I had a class last week and this was a scenario brought to class. The nurse evaluated the patient with symptoms and discussed the patient with the doctor much the same issue as brought up in an earlier post here. This is an established patient but the physican does not see the patient on this encounter. The physician tells the nurse what to do and what to communicate to the patient. Well to make a long story short the nurse "missed" something in her "evalustion" so therefore the physician did not get all the information, the patient then became very ill a few days later and now is in intensive care. This is a real scenario. If the physician has not evaluated the patient in a previous visit for the same thing then how is the malpractice insurance going to view this. Perhaps this should be one of the first places to check to verify that this can be done. I'm just sayin.
 
One document I keep handy is "Documentation Requirements for CPT 99211" which can be found on www.trailblazerhealth.com. We are a large urology practice and come across this scenario all the time. If the patient only drops off a urine specimen, only the u/a is billed. If, however, there is face-to-face encounter with the patient with either the physician or ancillary staff, a 99211 can be billed (without modifier -25 which is the case for the majority of the insurances we deal with). Hope this helps.

Zaida Aquino, CPC
Northern Virginia Urology
 
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