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When is ok to bill a 99211?

  1. #1
    Default When is ok to bill a 99211?
    Medical Coding Books
    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?
    Chrissy, CPC

  2. Default
    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.

  3. #3
    Madison Area Chapter in Madison WI
    I agree.
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email] - website

  4. #4
    Milwaukee WI
    Default 99211
    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

  5. #5
    If you go to, you will find a great article called Documentation Requirements for CPT Code 99211. You may want to print it out for future reference. Hope this is useful.

    Zaida, CPC

  6. Default
    In reference to the last response regarding the trailblazer article, I searched for it and here's the link:

    Megan, CPC

  7. #7
    Default 99211
    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
    Last edited by ILHC; 03-26-2014 at 10:58 AM.

  8. #8
    Richmond Virginia
    If you read the desription in CPT under 99211 it says "may or may not require the presence of a physician or other qualified health care professional"

    See also attached doc that defines who a health care professional is.

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