Love Coding!
Expert
Is a e/m code 99211 billable and payable with 36416 venipuncture, 85610-QW protime?
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Wiki procedure codes 99211, 36416, 85610-QW ?
- Thread starter Love Coding!
- Start date
sky
Guest
pro-times
i'm having the exact same problem. the ma's in the office do the pro-time & they insist that we can bill a level 1 e/m. they say they are providing education. EVERY claim submitted with 99211, 36416, 85610 is being denied.
SOMEONE PLEASE HELP!! I need something in black & white to let them know how to do this. The ma's have the doctors convinced this is appropriate to get more money for the visit.
i'm having the exact same problem. the ma's in the office do the pro-time & they insist that we can bill a level 1 e/m. they say they are providing education. EVERY claim submitted with 99211, 36416, 85610 is being denied.
SOMEONE PLEASE HELP!! I need something in black & white to let them know how to do this. The ma's have the doctors convinced this is appropriate to get more money for the visit.
tpontillo
Guest
mitchellde
True Blue
Here is an excerpt from a recent publication regarding the OIG focus for 2012 on incident to and 99211 encounters:
CPT® Definition of 99211:
"Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services." (CPT® 2010)
Criteria for billing 99211 Incident-to:
Must be an established patient
There must be an established plan of care
There must be an E/M service provided by an employee of the physician
Must be provided in the office
There must be direct physician supervision
Code 99211 should not be used if the sole purpose is:
Giving the patient an injection
Drawing blood, venipuncture (*INR/Coumadin clinic*)
Writing a prescription renewal
Making telephone calls
Also just to clarify a venipuncture is 36415, a fingerstick is 36416
CPT® Definition of 99211:
"Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services." (CPT® 2010)
Criteria for billing 99211 Incident-to:
Must be an established patient
There must be an established plan of care
There must be an E/M service provided by an employee of the physician
Must be provided in the office
There must be direct physician supervision
Code 99211 should not be used if the sole purpose is:
Giving the patient an injection
Drawing blood, venipuncture (*INR/Coumadin clinic*)
Writing a prescription renewal
Making telephone calls
Also just to clarify a venipuncture is 36415, a fingerstick is 36416