Wiki Provider questions

[sherriev]

I have a provider who has been asking me a lot of questions. I am a new coder and some of this has been overwhelming. The provider is wanting to bill a 99212 for handing out medications from Patient Assistance Programs because she is often has a discussion with the patient or patient's family. She is also wanting to bill a 99211 for a nurse's visit if for instance a patient has high bp and is coming in for a refill of a stimulant. She wants the patient's bp checked before handing out the refill. Any thoughts?

 

[Pam Warren]

First, congratulations that your provider wants to communicate with you! I can't tell you how many people on this board are envious that you have a physician who is seeking your advice.

Secondly, familiarize yourself with the E&M guidelines, in terms of what needs to be documented, and what is appropriate to bill for. Look at your local contractor's billing guides to clarify any additional expectations. This kind of work is where your research skills will be put to good use. I think you're learning early what all coders eventually find out....just passing the exam doesn't make you a coder. Learning, and applying what you learn about the different scenarios and aspects of the revenue cycle is what makes you a coder.

To answer your question, your provider can bill for an office visit if there is a chief complaint, there is medical necessity and key components or appropriate time is documented. Look at your E&M guidelines to determine the amount of time (it will be different for each patient, based on length of discussion), and provider must document total time and that greater than 50% of that total time is spent in counseling and coordination of care. You cannot, however bill a 99211 on the same day as another E&M, but you can bill a 211 if the patient comes in only for a BP check, as long as your incident-to requirements are met (check CMS E&M guidelines for a discussion of incident-to).

 

[mcwriter]

CPT codes 99495 and 99496

Hi Pam: could I get a copy of the guide you posted for these codes? I'm getting questions from providers.
Thanks,
Mary Fitzgerald, MS, RN, CPC

 

[Pam Warren]

Mary, they're on the CMS website. Here's the link, since the file is too large to upload here.
www.cms.gov/Outreach-and.../eval_mgmt_serv_guide-ICN006764.pdf


Also you have to check with your local carrier. Ours is NHIC (northern New England), and here's the link for those billing guides, http://www.medicarenhic.com/ne_prov/publications.shtml

but you will need to determine who administers Medicare for your area.