Results 1 to 8 of 8

99211 vs 96372 - reported unless

  1. #1
    Default 99211 vs 96372 - reported unless
    Exam Training Packages
    I'm confused on this one! I have read other sources that says 99211 cannot be reported unless the physician is in the office (incident-to)

    Medicare claims processing manual states:
    "The CPT 2006 includes a parenthetical remark immediately following CPT code 90772 (Therapeutic, prophylactic or diagnostic injection; (specify substance or drug); subcutaneous or intramuscular.) It states, “Do not report 90772 for injections given without direct supervision. To report, use 99211.”
    This coding guideline does not apply to Medicare patients. If the RN, LPN or other auxiliary personnel furnishes the injection in the office and the physician is not present in the office to meet the supervision requirement, which is one of the requirements for coverage of an incident to service, then the injection is not covered. The physician would also not report 99211 as this would not be covered as an incident to service."

    96372 cannot be reported unless the physician is in the office. So, what do you do? If neither can be reported without physician present, why even provide the service if the physician is not in office.
    Can anyone clarify for me please? Would appreciate all answers!

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Anna, my take on this is "direct supervision" -
    Direct supervision generally means to be physically present, or within an immediate distance, such as on the same floor, and available to respond to the needs of something or someone. Precise definitions vary by context and governing entity. For eaxample, in the context of employment law, it may involve defining the degree of control over a worker's tasks. Direct supervision on a job may be defined by the degree of supervision by a person overseeing the work of other persons, by which the supervisor has control over and professional knowledge of the work being done.

    so, if the physician is not in that building, not available for "supervision" then it'll be the so called "nurse visit" E/M code, along with the J-code meds. (direct supervision doesn't mean the physician has to be in the room and personally observe the injection given).
    We use the "new" code the same way we did with the old one (90772) regarding "direct supervision". We haven't had any issue with payment.

    anybody else?.....
    Donna, CPC, CPC-H

  3. #3
    Default 99211 vs 96372
    I guess what I'm asking is this:
    If Dr is at hospital doing rounds, his office is open for nurses to provide services (B/P checks, injections, etc). How can they provide injections in the office if the physician is at the hospital when the rules state that neither the 99211 or the 96372 will be covered?
    I'm really struggling with this. Should they not do injections when the physician is elsewhere but continue with other services?

  4. #4
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    I feel the same way. The provider is suppose to be available if the pt has an allergic reaction to the medication. How far away is the hospital?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    OHHH!!... I get the question now! (I see)... but I guess I was under the impression that for the 99211 E/M - it's for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimual. Typically, 5 minutes are spent performing or surpervising these services.

    I've never seen your finding of: "This coding guideline does not apply to Medicare patients. If the RN, LPN or other auxiliary personnel furnishes the injection in the office and the physician is not present in the office to meet the supervision requirement, which is one of the requirements for coverage of an incident to service, then the injection is not covered. The physician would also not report 99211 as this would not be covered as an incident to service."
    Is that guideline on CMS site, or where is it?

    and if that's the case,... I question it too! Apparently, we code non Medicare only this way then. hmmm,.....
    Donna, CPC, CPC-H

  6. #6
    Location
    Evansville Indiana
    Posts
    451
    Default 99211
    CPT assistant August 2008 states:
    "CMS provides some direction for reporting code 99211 for visits in which only the nurse sees the patient and gives an injection. CMS notes that it is not correct to report an E/M service if the nurse services are only related directly to the injection itself. "
    "If the nurse provides the 99211 visit, it is reported under the physician's name and tax ID number, making it inherently an "incident to" service. In such situations, it is a service restricted to established patients and requires the supervising physician's "direct supervision", which is defined by CMS as the physician being physically present in the office suite (not in the patient's room) and immediately available to provide assistance.

    This seems to state that you cannot charge the 99211 either, if the physician is not in the office suite. Personally as an RN I would be uncomfortable giving injections, with potential side effects, without immediate assistance available. This could be a legal issue if something happened and the physician was not available to assist.

    It sounds to me like CMS, not allowing the charge for either the injection or the E/M code, is discouraging this practice, and in my opinion rightfully so.

  7. #7
    Default 99211 vs 96372
    Quote Originally Posted by dmaec View Post
    OHHH!!... I get the question now! (I see)... but I guess I was under the impression that for the 99211 E/M - it's for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimual. Typically, 5 minutes are spent performing or surpervising these services.

    I've never seen your finding of: "This coding guideline does not apply to Medicare patients. If the RN, LPN or other auxiliary personnel furnishes the injection in the office and the physician is not present in the office to meet the supervision requirement, which is one of the requirements for coverage of an incident to service, then the injection is not covered. The physician would also not report 99211 as this would not be covered as an incident to service."
    Is that guideline on CMS site, or where is it?

    and if that's the case,... I question it too! Apparently, we code non Medicare only this way then. hmmm,.....

    I found this in the medicare claims processing manual. It is section 30.5 under C the last paragraph. So, you can see my dilemma, I have been told that the nurses can charge this, then I find this medicare guideline and I'm really not sure any longer.
    I think the more I get into this the more confused I get!!!

  8. #8
    Default 99211 vs 96372
    Quote Originally Posted by cheermom68 View Post
    CPT assistant August 2008 states:
    "CMS provides some direction for reporting code 99211 for visits in which only the nurse sees the patient and gives an injection. CMS notes that it is not correct to report an E/M service if the nurse services are only related directly to the injection itself. "
    "If the nurse provides the 99211 visit, it is reported under the physician's name and tax ID number, making it inherently an "incident to" service. In such situations, it is a service restricted to established patients and requires the supervising physician's "direct supervision", which is defined by CMS as the physician being physically present in the office suite (not in the patient's room) and immediately available to provide assistance.

    This seems to state that you cannot charge the 99211 either, if the physician is not in the office suite. Personally as an RN I would be uncomfortable giving injections, with potential side effects, without immediate assistance available. This could be a legal issue if something happened and the physician was not available to assist.

    It sounds to me like CMS, not allowing the charge for either the injection or the E/M code, is discouraging this practice, and in my opinion rightfully so.
    I agree with you, I would be afraid of something happening and no help available. I've taken this on to my supervisor and we'll see where we go from here.

Similar Threads

  1. 99211 or 96372
    By nikki_coder in forum E/M
    Replies: 1
    Last Post: 06-26-2015, 09:41 AM
  2. 99211 with 96372 and J10180
    By april.king in forum Family Practice
    Replies: 4
    Last Post: 06-12-2015, 09:16 AM
  3. Billing 99211 with 96372
    By CMUNS in forum Billing/Reimbursement
    Replies: 2
    Last Post: 12-08-2014, 10:38 PM
  4. 99211 vs 96372
    By melissa.wolf in forum OB/GYN
    Replies: 4
    Last Post: 10-13-2014, 01:27 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.