What is the reasoning for this question? (Leveling)

AKeys89

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Study Question:

Visit w/ RN for Diabetes Education.

My answer was: 99212 as the scenario does not provide much information. Even when trying to figure out the HEM, it didn't lead me anywhere but 12 was the best answer since it seems to be the simplest.

The answer key says the answer is 99211. I don't understand why this is the answer. There aren't any details listed under this code.

Can anyone help?!:confused:
 

JCaillouet

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Nurse Visit

No provider needed for the established visit. A Nurse Counseling, etc can be billed 99211...
 

JCaillouet

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Breaking it down

eport this code when an established patient receives an evaluation and management service, typically for 5 minutes, that does not necessarily require a physician or other qualified health care professional to see the patient.

Clinical Responsibility
For 99211, the provider, often a nurse, spends an average of 5 minutes face to face with an established patient. This service does not require a physician or other qualified healthcare provider, such as a physician assistant, to see the patient. The presenting problem is typically minimal. A patient is considered to be established if the same physician or qualified healthcare practitioner, or any physician or qualified healthcare practitioner in the group practice, or any physician or practitioner of the same specialty who is billing under the same group number, has seen the patient for a face to face service within the past 36 months.

Tips
Coders often refer to 99211 as a nurse visit, but the code may apply whether the patient sees the physician, or a nurse, or other applicable nonphysician practitioners, called NPPs, such as physician assistants, nurse practitioners, and certified nurse specialists. However, in practice, visits with physicians and NPPs typically qualify for a higher level code.
 
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