Wiki coding 99211 correctly?

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LuckyLily

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I would like some clarification if I am understanding the use of 99211 correctly.

If billing 99211 as an 'incident to' the patient has to be established and have seen the provider previously for what they are coming back in for. There must be an order from the provider for this follow up. This order should be in patient chart for the coder to view.

If a patient is in another part of the clinic that is not medical, and it is determined the patient has high blood pressure and is sent to medical for evaluation of the blood pressure, a nurse sees patient and documents a discussion with the doctor about blood pressure this would be a 99211? It does not have to follow the 'incident to' rules? What if there is no documentation of a doctor discussion? This patient was not asked by the doctor to have a follow up on blood pressure.

Or are all nurse visits considered 'incident to'?

I've looked at a lot of articles already and would like some clarification. Thanks.
 
So are you saying that the blood pressure check was recommended by a non-medical person (ie: an esthetician or trainer or nutritionist or something like that), and the patient didn't see a doctor, only a nurse (RN/LPN)?
 
This patient was referred over to medical and only saw a nurse. There is no documentation that the nurse discussed with a doctor. The encounter was signed by a doctor.
 
The nurse can follow orders only from the provider she is employed by. If the provider did not see the patient first and order subsequent BP checks then you cannot bill it as incident to and it cannot be a 99211.
 
Does this mean that all 99211 are to be 'Incident-To'. Is there any other circumstance to where you can bill a 99211?
 
99211, as with almost all medical services, but meet always 'incident to' requirements as a condition of coverage. CMS requires, as do many payers, that all services be a part of a physician's plan of care in order to be covered. There are a few exceptions to this, such as immunizations that may be administered under a 'standing order', which is why you can have a flu shot at a pharmacy and it may be paid by insurance. Commercial payers may add additional benefits to their plans that are outside of physician-ordered services, such as massage, acupuncture, health plan memberships. But 99211 is, by CPT definition, an professional E&M service, which must be medically necessary and is not exempted from 'incident to' requirements, unless otherwise specified by individual payer policy.
 
99211 for port disconnect

There is no documentation, only a flow sheet from the nurses notes.
There is no chief complaint, or any indication for visit other than 'port disconnect' listed.
Does this constitute enough for a 99211? wouldn't the disconnect be part of the connect portion of the services?
Should there be documentation to support the physician's plan of care? Seems this is most like a 96521 not a 99211 or maybe an unlisted procedure.
Thanks for your help
 
Coding analyst

Scenario:
A patient is coming to our clinic for a shot of epogen. He has a weekly order. As usual hemoglobin and hematocrit labs are done before any injection. The RN does some vital signs, including height and weight while waiting for results. She sees the results are at the level that will not require an injection ( per MD order). She speaks with the provider and informs them of the values. No injection given. Is it appropriate to charge an 99211?

THis is bugging us. Any advice is appreciated.
 
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