Wiki Office visit or injection?

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What am I supposed to bill for when a patient comes in for an injection of a drug and sees the nurse...IF no doctor is in the building?

Do I JUST use a 99211 with the drug? Or do I use an injection code?

I read this on FPM " One word of caution about 99211: You can't bill for the administration of an injectable medication (90782) or for the administration of an immunization (90471, 90472) and a nursing visit at the same time. You can either bill for the 99211 plus the medications or bill for the injection plus the medications. When the nurse must make an evaluation of the patient (e.g., when giving a depo-progesterone shot, the nurse must consider, “might the patient be pregnant?”), then our practice uses the 99211. If the nurse must only give an injection, we use the injection codes. "
 
If this is a private physician practice and no doctor is in the building, then anything your nurse does would not meet the supervision requirements necessary to bill as an 'incident to' service. They really should not be performing or billing anything in that situation. I would suspect that this could also be a compliance and malpractice liability risk. With few exceptions, medical office staff should not be providing patient care without supervision by a physician on site.
 
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Super. That confirms what I suspected. Thank you for answering this so quickly.

So, my follow-up to you or anyone else is -
If doctor is in the building and doesn't see the patient but wrote an order for the injection two months ago (last visit) - the nurse provided the injection and didn't do much else....we would bill 96372 and the J code. Is this correct?

If the nurse did a work up, did a pregnancy test for example and then the injection - the nurse would bill for 99211-25, 96372, and J code. Is this correct?
 
If doctor is in the building and doesn't see the patient but wrote an order for the injection two months ago (last visit) - the nurse provided the injection and didn't do much else....we would bill 96372 and the J code. Is this correct?

If the nurse did a work up, did a pregnancy test for example and then the injection - the nurse would bill for 99211-25, 96372, and J code. Is this correct?

If they just did an injection, then yes, you just bill the injection and the drug.

If they are also performing an E&M, as mentioned in the passage you quoted above, you will not be able to bill both, even with a modifier 25, for payers that follow NCCI. Per the NCCI manual: "The drug and chemotherapy administration HCPCS/CPT codes 96360-96375,96377 and 96401-96425 have been valued to include the work and practice expenses of CPT code 99211." So you should only bill the injection in this case since the payment rate set for that service already includes any E&M service performed by a nurse on the same date.
 
Not sure what meds you are referring to, but in our office often times patients pick up their medications at the pharmacy and bring them, we just administer. A physician still has to write the order before administration can occur. In which case we just bill the injection (96372).
 
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