Wiki When is ok to bill a 99211?


Olathe, KS
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I am new to coding, have been doing it since June and I got no training whatsoever. I was told that we are to bill a 99211 if the nurse sees a patient and a doctor is in the office. The doc never sees the patient, just the nurse. Is this correct? Does anyone know where I can locate the rules for this? :confused:
Yes, a 99211 is used for a nurse visit such as giving an injection or patient education. The patient does not see the doctor just the nurse. if you look up 99211 in the CPT it says patient does not usually see the physican. I hope this helps.

Here's the exact description of 99211 from 2008 CPT Professional edition (pg 10)

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. (emphasis added by FTB)

The 99211 code "may not" require the presence of a physician. SO it can defintely be coded for a nurse-only visit. BUT, it can also be coded (if appropriate) for a physician's visit.

(Just my little soap box - I get so tired of hearing it referred to as a "nurse visit" as if a doctor can't use this code.)

F Tessa Bartels, CPC, CPC-E/M

I am also new to medical coding, I wanted to clarify who can bill the 99211, I am assuming this is independent and licensed nurses. Does this include LPN under the supervision of a FNP?

Dabborah, CPC
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