Nurse Visit 99211

[Tricia13]

I'm in Colorado and my MAC is Trailblazer. I am still confused as to when you can use the 99211. I understand a physician has to see the patient prior to ancillary staff seeing the patient therafter (incident to seeing the physician), and if it's face to face, and if there are no other CPT code to use (say for irrigating an ear when the physician has previously seen the patient for this condition). What are the other circumstances then? We don't use it for any labs or screens? When should we use it?

 

[rthames052006]

I'm in Colorado and my MAC is Trailblazer. I am still confused as to when you can use the 99211. I understand a physician has to see the patient prior to ancillary staff seeing the patient therafter (incident to seeing the physician), and if it's face to face, and if there are no other CPT code to use (say for irrigating an ear when the physician has previously seen the patient for this condition). What are the other circumstances then? We don't use it for any labs or screens? When should we use it?

Take a look in Appendix C in your CPT book( located near the back of your book) they have examples of all E/M codes listed there for some guidance.

 

[britbrit852003]

I am in Colorado as well and my office has come up with the following guidelines for billing nurse visits:

· Procedure code 99211 should only be billed by the physician's nursing staff when they are providing medically necessary services. Medical necessity will have to be determined by the physicians at each office and reimbursement should never be a contributing factor in this decision.
· This code is for an established patient only.
· A physician must always be on site and must always sign the
office note to indicate their supervision.
· If it's not medically necessary for the nurse staff to provide an E/M service during an injection then only charge the injection with the appropriate administration code.
· The nursing staff will need to document the chief complaint
(CC) and at least two of the following: History, Exam and
Medical Decision Making (MDM).

E. Examples
A. 99211 with blood draw for monitoring of drug level
CC- Patient in for Coumadin monitoring
History- Patient reports no gum bleeding since changing to soft-bristled toothbrush. No other unusual bleeding noted.
Exam- vital signs
MDM- Let the doctor know of any unusual bleeding and continue on your low fat diet. F/U next week.
B. 99211 with UA for recheck of UTI
CC- Patient in for recheck of UTI
History- Patient no longer has any urinary frequency or burning.
Exam-vital signs
MDM- UA is negative for UTI. I instructed the patient to F/U with the doctor if her symptoms return.
C. 99211 with an immunization
CC- Patient in for his Varicella vaccine.
History- Patient has no fever, cough or congestion currently and is back to his playful self.
Exam- weight, respiratory effect
MDM- Reviewed patient information sheet with mom and instructed her to call with any concerns