Wiki Can't I bill 99211 with 86318?

[Katwood]

I've received a denial from Medicaid for billing 99211 and 86318. The patient was seen by a medical assistant for a rapid strep test. Medicaid is telling me that billing these together is unbundling. I thought that the 86318 was for the test only, and that the 99211 was for administering it. If you can please include some references to go with your responses - I need to get info for a hearing request.

Thanks!

 

[mitchellde]

If the only reason the patient was in for for the administration of a rapid strep with no face to face visit with the physician, then you cannot bill the 99211 as the incident to provisions have not been met. To use a 99211 for ancillary personnel it must a followup encounter as ordered by the physician in a previous encounter for the same reason, have had strep in the past does not count. And the provider must be onsite. So a visit for a rapid step is the code for the lab only as there has been no face to face involvement by the provider.