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99211

  1. #1
    Default 99211
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    Just want to confirm that you cannot use a modifier with the nurse visit.

  2. #2
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    Columbia, MO
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    99211 is not a nurse visit, it is a physician level that the physician is allowed to bill when qualified ancillary persons are in the room with the patient following the physician's orders from a previous encounter while the physician is in the office suite area. If there is another CPT code for the service being provided such as 96372 for an injection then you would not use the 99211 instead of, or in addition to. so there is normally no need for a modifier. If you can provide specifics for your question it would be helpful for a more direct answer.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    this was a nurse visit for a PPD read and immunizations were given

  4. #4
    Location
    Columbia, MO
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    you do not charge for the PPD read that is included in the initial code.. for the vaccines you charge the admin code and the vaccine.. no 99211 is used for this scenario.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
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    according to Coding Intelligence, you do bill the 99211 for the PPD read

  6. Default
    We've never been paid for a PPD read....agreed, it's included in the initial code. But we learned this through trial and error. :-)

  7. #7
    Location
    Columbia, MO
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    I am not certain who coding intelligence is, however I know there has been much back and forth over this issue. Most payers will tell you that the reading is considered to be a part of the entire PPD test and is included. It is hard logic to fight.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
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    My SelectCoder CCI Validator suggests that you can bill both the 99211 and 86580 without any modifiers. However, as most of us know, just because something might be validated through an automated process, doesn't mean it's Correct Coding or will get paid.

    I agree that 86580 should include some type of reading and would not need a 99211, unless something separate occurred during the visit.
    "When you have exhausted all possibilities, remember this: You haven't!"
    -Thomas Edison

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