Wiki using CPT CODE 99211

[dshull81401]

I have a couple of PT/ OT and wound care hospital based, using CPT Code 99211. for dressing changes, ostomy nurse visits and for wound care, now the problem is they are using this CPT Code on the initial visit and on every visit after that.
and I'm getting denials.
I'm looking for advice and a guideline that I can show that they should not be using CPT Code 99211 like this. Thank You

 

[AmandaBriggs]

Is this for inpatient services? If so, just the basic description of 99211 should help as it is only for office or other outpatient visits. Our facility has created dummy codes for these types of providers to use to track their services to support the FTEs. These types of services are typically not separately billable and are instead bundled into the patient's room and board.

 

[TThivierge]

Hi,
Using CPT 99211 in most insist for nurse care or QHP technicians. You CANNOT use CPT 99211 with setting such as giving patient injection or chemotherapy Cancer services. CPT 99211 is not for every OP visits and on initial visits when the treated as new or est .pt. Nurse needs to take patient vitals, wound dressing, Etc to assist provider.
Lady T

 

[dshull81401]

Is this for inpatient services? If so, just the basic description of 99211 should help as it is only for office or other outpatient visits. Our facility has created dummy codes for these types of providers to use to track their services to support the FTEs. These types of services are typically not separately billable and are instead bundled into the patient's room and board.

This is in our output therapy clinic.

 

[luvbuix]

dressing changes other than under anesthesia are not separately billable- if there are codes for ostomy procedures they would need to be billed using those codes & under the MD. wound care has it's own codes but a nurse cannot bill under her/his own name for those- they would need to be billed under the MD/APP/PT/OT. be careful with using 99211 frequently- you could be red flagged, all claims held, records requested, & a refund requested (or worse!) by the payer.

 

[dshull81401]

dressing changes other than under anesthesia are not separately billable- if there are codes for ostomy procedures they would need to be billed using those codes & under the MD. wound care has it's own codes but a nurse cannot bill under her/his own name for those- they would need to be billed under the MD/APP/PT/OT. be careful with using 99211 frequently- you could be red flagged, all claims held, records requested, & a refund requested (or worse!) by the payer.

Thank You for your help.