Wiki Referrals without exam or treatment

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karlam

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What is everyone using for these visits where the patients are coming in for just a referral and no examination or treatment was rendered? Thanks!!!!
 
Coding King, I'm not sure how they could use a 99211 if, as stated in the original post, no treatment or examination was done.

karlam, are you working in a PCP's office and the patients who require referrals to other providers, because of their insurance plan, are stopping by your office to pick up the referral authorization paperwork? Is your office calling the specialist's office and setting up the patient appointment and also sending over any necessary patient records to coordinate care? If you're coordinating care, you may be able to use another code for that. I can't remember the code right now because I don't have my CPT book handy.

Tom Cheezum, O.D., CPC
 
Coding King, I'm not sure how they could use a 99211 if, as stated in the original post, no treatment or examination was done.

karlam, are you working in a PCP's office and the patients who require referrals to other providers, because of their insurance plan, are stopping by your office to pick up the referral authorization paperwork?
Tom Cheezum, O.D., CPC
 
Exam and treatment is not necessary. I brought it up and referenced the article because there wasn't enough info to determine what is happening here. If it necessitated the patient to present to the office when this is something that could be done over the phone, its possible enough work was done to substantiate this code which is why I listed it as a possibility. As you referenced if its just to pick up a form, which doesn't even involve more than a visit to the waiting room, then no its not billable.

An E/M service must be provided. Generally, this means that the patient’s history is reviewed, a limited physical assessment is performed or some degree of decision making occurs. If a clinical need cannot be substantiated, 99211 should not be reported. For example, 99211 would not be appropriate when a patient comes into the office just to pick up a routine prescription.
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Last edited:
CodingKing said:
Exam and treatment is not necessary. I brought it up and referenced the article because there wasn't enough info to determine what is happening here. If it necessitated the patient to present to the office when this is something that could be done over the phone, its possible enough work was done to substantiate this code which is why I listed it as a possibility. As you referenced if its just to pick up a form, which doesn't even involve more than a visit to the waiting room, then no its not billable.
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My question is more for the diagnosis code. We used to use the V68.81 - Referral of patient without exam or treatment.
 
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