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99211 "Nursing Assessment"

  1. #1
    Kansas City, MO
    Default 99211 "Nursing Assessment"
    Medical Coding Books
    Does anyone know what the supervision rules are for billing this code? I have a patient that was in to speak to the nurse and she did a full assessment of the patient and would like to bill the 99211 but there was not a doc in the office suite during this visit. Can she bill the 99211? This is a RN not a NP.

  2. #2
    Following Medicare's guidelines, a 99211 could be billed by a PA (not an RN) if the "incident to" requirements are met. However, for "incident to" services, a physician must be present in the office indicate your physician was not in the office suite at the Time of Service. Also, 99211 must consist of both the evaluation and management elements. Based on your scenario, the RN would not bill a 99211.

    Zaida V. Aquino, CPC

  3. #3
    We have certain scenarios where the nurses can bill 99211 "incident to" but not if a physician is not in the suite.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    National Advisory Board Member 2018-2021, Region 6 Great Lakes
    Minneapolis AAPC Chapter, Education Officer 2018
    AHIMA ICD-10-CM/PCS Trainer
    AAPC National ICD-10 Trainer

  4. #4
    Jacksonville, FL River City Chapter
    Services of ancillary staff, including RNs, can be billed by the physician if they were adequately supervised and represent an expense to the physician.

    Medicare requires its incident to rules to be met, which means the physician must already have seen the patient before for this particluar problem and be present in the office for the later visit with the nurse.

    Also, the advice given by a nurse can not exceed his/her scope of practice, and the physician should monitor this.

    Seth Canterbury, CPC, ACS-EM

  5. #5
    Stuart, FL
    I agree with all the other replies. A nurse visit is considered an incident-to service and must have a physicians presence to bill ther service.

    Rachael Milley, CEMC, CPMA, CPC, PCS
    Holy Cross Hospital
    Coding Compliance Manager

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