General Question about 99211

[mbcallahan]

How and when is this used? I was taught that it never was used with the injection codes for trigger points, but otherwise should be used, especially with blood draws and immunizations. Now we have people billing claims that aren't utilizing that code with those services. Is that correct? Thanks for any info!

 

[mitchellde]

The 99211 is a physician level that may be use when ancillary personnel are see a patient in followup to a physicians orders while the physician is on site - incident to. You cannot use a 99211 for an injection or blood draw, because the visit is scheduled as per the physician order so we already know the patient is coming in and why, the nurses work is an intergral part of the injection or blood draw service so it may not be split out for separate reimbursement, and since a code exists for the injection and blood collection, we must use those codes. I have a memo regarding the 99211 if you would like a copy or just google up the 99211 and injections subject and you will get a ton of information. I hope this helps.

 

[RebeccaWoodward*]

Drug Administration Services and E/M Visits Billed on Same Day of Service

Carriers must advise physicians that CPT code 99211 cannot be paid if it is billed with a drug administration service such as a chemotherapy or nonchemotherapy drug infusion code. This also includes therapeutic or diagnostic injection codes. Therefore, when a medically necessary, significant and separately identifiable E/M service (which meets a higher complexity level than CPT code 99211) is performed, in addition to one of these drug administration services, the appropriate E/M CPT code should be reported with modifier -25. Documentation should support the level of E/M service billed. For an E/M service provided on the same day, a different diagnosis is not required.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

30.6.7